Medicaid Expansions

The ACA gives states the option to implement a Basic Health Program (BHP) that covers low-income residents through state-contracting plans outside the health insurance marketplace, rather than qualified health plans (QHPs). BHP offers the prospect of improved affordability for low-income residents, fiscal gains for some states, and reduced churning. However, it also poses financial risks for states and has implications for state marketplaces. This paper summarizes the federal policies on BHP, including the requirements for BHP as well as the methodology for determining federal BHP payments. It also analyzes the key trade-offs facing states as they decide whether and, if so, how to implement BHP, with a particular focus on the impact of BHP on state budgets and the size, stability, and risk level of state marketplaces.
 

This letter provides guidance on the types of Medicaid coverage that qualify as minimum essential coverage (MEC), which includes certain coverage for low-income pregnant women, coverage for medically needy individuals, and coverage under an 1115 waiver program. This letter also clarifies how other Medicaid and CHIP coverage is regarded as MEC, and discusses related federal guidance issued by the Internal Revenue Service (IRS) to ensure pregnant women are not adversely impacted by a decision either to recognize or to not recognize certain coverage as MEC. Finally, this letter discusses hardship exemptions and the availability of special enrollment periods for individuals enrolled in Medicaid coverage that is not MEC.
 

Financial incentives offer a new tool for Medicaid programs to encourage beneficiaries to choose healthy behaviors. Programs serving non-Medicaid populations have demonstrated that financial incentives can help influence healthy behaviors, enhance long-term health outcomes, and reduce health care costs. Several states are considering incentive strategies within new Medicaid expansion programs. This brief explores how financial incentives can be used to influence healthy behaviors. It reports on findings from past Medicaid healthy behavior incentive programs; highlights current Medicaid incentive approaches, including New Mexico’s model; and offers recommendations for states that are establishing or modifying programs to encourage healthy behaviors in Medicaid.
 

To increase support for physicians providing primary care for Medicaid beneficiaries, and to improve access to primary care as Medicaid coverage expands, the ACA increased Medicaid payment rates for many primary care services to Medicare fee levels in 2013 and 2014. The rate increase applies only to physicians serving Medicaid beneficiaries in both fee-for-service and managed care. The federal government funded 100% of the primary care fee increase relative to the rates states were paying as of July 1, 2009. This report assesses states’ plans to extend the primary care rate increase beyond December 31, 2014.
 

For more than a decade, economic conditions, including two major recessions, were the primary driver of changes in Medicaid spending and enrollment. In FY 2014 and in budgets adopted for FY 2015, enrollment and spending have grown with implementation of the major coverage provisions in the ACA, including the federally financed Medicaid expansion. This report provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2014 and 2015 (FY 2014 and FY 2015) and an overview of Medicaid financing. Findings examine changes in overall enrollment and spending growth and compare expansion and non-expansion states.
 

One major concern about the Medicaid expansion is that a high level of need among the newly eligible may lead to runaway costs, which could overwhelm state budgets when federal subsidies no longer cover 100 percent of the expansion population's costs in 2017. Although cost increases as a result of the newly eligible are likely, an important question is whether these increases will be temporary or permanent. Evidence from California's Low Income Health Program suggests that cost and utilization increases among newly eligible Medicaid beneficiaries will be mostly temporary.

This document provides the methodology and data sources necessary to determine federal payment amounts made in program year 2016 to states that elect to establish a Basic Health Program under the Affordable Care Act in order to offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through affordable insurance exchanges.
 

States across the country are embracing integrated care delivery models as part of their efforts to deliver high-quality, cost-effective care to Medicaid beneficiaries with both physical and behavioral health needs. The Medicaid expansion authorized by the ACA brings greater import to these efforts, as millions of previously uninsured low-income adults—many at increased risk of having behavioral health conditions—gain coverage. Drawing on a review of the literature and interviews with consumers, providers, payers, and policymakers, this report explores strategies states are deploying to promote integrated care for this medically complex and high-cost Medicaid population.
 

The Medicaid primary care rate increase, a provision of the Affordable Care Act, requires Medicaid programs to reimburse primary care providers at Medicare levels for two years. The increase was intended to ensure sufficient provider participation as the Medicaid population expands. As the temporary provision enters its final months, a number of state and federal policymakers are considering extending the rate increase into 2015 and beyond. This new brief draws from interviews with policy experts and stakeholders across the country to assesses the policy's successes and failures. The brief examines the rate increase through the provider's lens, reviews its impact in meeting access and quality goals, and outlines considerations for states interested in extending and strengthening the provision to better meet its goals.

Reducing readmissions is a national priority for payers, providers, and policymakers seeking to improve health care and lower costs, and readmissions are a significant issue among patients with Medicaid. This guide from AHRQ is designed to help acute care facilities adapt or expand existing Medicaid readmission reduction efforts; develop Medicaid readmission reduction strategies using the guide’s roadmap featuring 13 customizable online tools; comply with the Centers for Medicare and Medicaid Services’ Conditions of Participation requirements for standard, improved and transitional care for all patients; and develop partnerships across other settings. The guide is the only federal tool available that is tailored to the adult Medicaid population.