Medicaid Expansions

In 2008, Oregon initiated a limited expansion of its Medicaid program for low-income adults through a lottery drawing of approximately 30,000 names from a waiting list of almost 90,000 persons. Selected adults won the opportunity to apply for Medicaid and to enroll if they met eligibility requirements. The researchers used the random assignment embedded in the Oregon Medicaid lottery to examine the effects of insurance coverage on health care use and health outcomes after approximately 2 years. They found that insurance led to increased access to and utilization of health care, substantial improvements in mental health, and reductions in financial strain.

Accountable care organizations (ACOs) are gaining momentum in Medicaid as an innovative model to improve health care quality and reduce costs. As states design ACO programs for Medicaid populations, they must identify a robust set of quality measures that align with state and national goals and include a diverse array of measures to accurately evaluate the program's success. This technical assistance tool was developed to help states select quality measures for Medicaid ACO programs. It can be used to facilitate quality strategy discussions with the Centers for Medicare & Medicaid Services to achieve regulatory approval.

This bill constitutes the last step in the O’Malley-Brown Administration’s three-year effort to use the tools of the Affordable Care Act to enhance Marylanders’ access to quality and affordable health care. The bill puts in place the remaining policies necessary for the State’s health benefit exchange to begin operations and expands Medicaid eligibility to ensure coverage for the State’s most financially vulnerable. 

Medicaid cost $432 billion in 2011, and Medicaid spending is expected to grow to $795 billion by 2021. Concerns over Medicaid’s contribution to fiscal pressures at both the federal and state levels have led some policy makers to urge reforms. One such proposed reform would be to impose a cap on the amount of federal spending per Medicaid beneficiary, or what’s called a “per capita cap,” so that any program spending growth would be linked to enrollment, not rising per beneficiary spending. This policy brief examines the issues surrounding per capita caps in Medicaid and explores other policy options for states and the federal government.

This chart, prepared by Manatt Health Solutions, allows states to explore different mechanisms to address the cost-sharing cliff in the Exchange and also to promote continuity of coverage and care as consumers transition across Insurance Affordability Programs. The chart provides a side-by-side analysis of coverage alternatives under state and federal consideration including: the Basic Health Program (BHP); the Bridge Plan; Qualified Health Plan (QHP) Premium and Cost-Sharing Support; maintaining existing Medicaid expansions above 133 percent FPL; and Premium Assistance. These options are compared against subsidized QHP coverage available under the ACA.

In this 2-page FAQ, CMCS reviews the premium assistance option under Medicaid. It also provides further detail for states interested in submitting demonstration proposals for providing premium assistance in the individual market.

The ACA expands Medicaid to 138% FPL in 2014, which would make millions of adults newly eligible for the program. However, if a state does not expand Medicaid, poor uninsured adults in that state will not gain a new coverage option and will likely remain uninsured. This brief provides an overview of current Medicaid and CHIP eligibility levels for nondisabled children and adults to provide better insight into the impact of the Medicaid expansion.

This checklist prepared by the National Academy for State Health Policy (NASHP) highlights the ACA Medicaid requirements that will take effect in the next two years, nearly all of which will apply to states regardless of whether the state chooses to expand Medicaid eligibility.  The checklist also highlights a few important optional provisions that states may want to consider as they plan for modernizing their Medicaid programs and complying with federal requirements.

The Centers for Medicare and Medicaid Services (CMS) has issued its final rule on the increased Federal Medical Assistance Percentage (FMAP) rates under the ACA. Beginning in January 2014, the federal government will cover 100 percent of the costs of newly eligible Medicaid beneficiaries through 2016, and then it will phase down to a 90 percent match rate by 2020.