web briefing for journalists: key issues around medicaid expansion efforts in the states wednesday,...
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Web Briefing for Journalists: Key Issues Around Medicaid Expansion Efforts in the States
Wednesday, February 18, 2015
Presented by the Kaiser Family Foundation
Rakesh Singh - Moderator
Vice President for Communications
Kaiser Family Foundation
Senior Policy Analyst
Kaiser Family Foundation
Laura Snyder – First Presenter
Associate Director, Kaiser Commission on Medicaid and the Uninsured
Kaiser Family Foundation
Robin Rudowitz – Second Presenter
Medicaid is being transformed under the ACA.
Delivery System Reforms
Health Insurance Coverage for Certain Individuals
AntiquatedEnrollment Process
Support forHealth Care System
Coverage for All Adults and Children Up to at Least
138% FPL at State Option
Modernized, SimplifiedEnrollment Process
Before ACA Vision
Shared FinancingStates and Federal Govt.
AdditionalFederal Financingfor New Coverage
NOTE: The June 2012 Supreme Court decision in National Federation of Independent Business v. Sebelius maintained the Medicaid expansion, but limited the Secretary's authority to enforce it, effectively making the expansion optional for states. 138% FPL = $16,424 for an individual and $27,724 for a family of three in 2015.
The ACA Medicaid expansion fills current gaps in coverage.
All states must modernize Medicaid application and enrollment processes.
ACA VisionPAST
Real-time determination
DataHub
$
#
Dear __,You are eligible for…
Apply in person Multiple options to apply
Provide paper documentation
Electronic verification
Wait for eligibility determination
MedicaidCHIP
Marketplace
No Wrong Door to Coverage
NOTES: Under discussion indicates executive activity supporting adoption of the Medicaid expansion. *AR, IA, IN, MI, and PA have approved Section 1115 waivers. Coverage under the PA waiver went into effect on 1/1/15, but the newly-elected governor has stated he will transition coverage to a state plan amendment. Coverage under the IN waiver is set to begin 2/1/15. NH has submitted a waiver to continue their expansion via premium assistance. WI covers adults up to 100% FPL in Medicaid, but did not adopt the ACA expansion.SOURCE: “Status of State Action on the Medicaid Expansion Decision,” KFF State Health Facts.http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/
Over half of states are currently implementing the Medicaid expansion.
WY
WI*
WV
WA
VA
VT
UT
TX
TN
SD
SC
RI PA*
OR
OK
OH
ND
NC
NY
NM
NJ
NH*
NV NE
MT
MO
MS
MN
MI*MA
MD
ME
LA
KY KS
IA*
IN* IL
ID
HI
GA
FL
DC
DE
CT
CO CA
AR*AZ
AK
AL Adopted (29 States including DC)Adoption under discussion (7 States)Not Adopting At This Time (15 States)
NOTE: Data show the year over year change in spending between SFY 2014 and SFY 2015. Expansion states include 28 states; Indiana, which adopted the Medicaid expansion after this survey, is included in the non-expansion state group.SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, October 2014.
Expansion states expect to see higher enrollment growth in FY 2015 with spending growth largely supported by federal funds.
The Medicaid expansion has implications beyond the Medicaid program.
Increased State Increased State Economic ActivityEconomic Activity
Increased Provider Increased Provider Revenue Revenue
Reduction in the Number Reduction in the Number of Uninsured of Uninsured
↓ Uncompensated Care Costs↓ State-funded health programs (e.g. Mental health)
Increased State SavingsIncreased State SavingsFederal + State Federal + State
FundsFunds
++
↑ Jobs and Revenues
Source: Kaiser Commission on Medicaid and the Uninsured.
The process for a state to adopt the Medicaid expansion requires partners at the state and federal level.
State Law-
makers
State Medicaid Agency
Federal Medicaid Agency (CMS)
State Law or
Regulation
Medicaid State Plan
Authorizationand
Appropriations
State Plan Amendment (SPA) or
Section 1115 Waiver
In order to adopt the Medicaid Expansion, States must make changes to:
Approved Waivers Proposed WaiversWaiver Provision AR IA IN MI PA* NH UT TN
Premium Assistance
X X X X X X
Premiums / Monthly Contributions
X X X X X X X
Healthy Behavior Incentives
X X X X X X
Benefits (NEMT) X X X X X X
Work Referral XReasonable Promptness
X
Retroactive Eligibility
X X X
Co-payments X X X
Note: *Governor Wolf in PA said he will transition from a waiver to a SPA
Most states are implementing the Medicaid expansion as set forth by law, but a limited number have approved or are seeking waivers.
Newly approved provisions
• Indiana waiver included approval for additional provisions:– 6-month lock-out period for not paying premiums (between 100-138% FPL)– Coverage to begin after 60 days or after payment of premiums– Authority to implement higher co-payments ($8 for first visit and $25 for subsequent
visits in the same year) for non-emergency ER use through § 1916(f)
• CMS has issued guidance to prohibit waivers to impose enrollment caps or implement partial expansion and access enhanced match
• CMS has denied proposals to:
– Impose premiums as a condition of eligibility for beneficiaries below poverty
– Waive certain required benefits such as EPSDT and free choice of family planning provider
– Impose work requirements as a condition of eligibility
What CMS approves or denies sets the guideposts for other states.
NOTE: Based on 2014 poverty thresholds.
In states that have not expanded Medicaid under the ACA, there are large gaps in coverage available for adults.
as of February 2015
46% FPL$9,100 for parents in a family of three
Notes: Excludes legal immigrants who have been in the country for five years or less and immigrants who are undocumented. The poverty level for a family of three in 2015 is $20,090. Totals may not sum to 100% due to rounding.Source: “Number of Poor Uninsured Nonelderly Adults in the ACA Coverage Gap,” KFF State Health Facts.http://kff.org/health-reform/state-indicator/number-of-poor-uninsured-nonelderly-adults-in-the-aca-coverage-gap/#.
Nationwide, there are 3.7 Million low-income adults estimated to fall into the coverage gap.
Total = 3.7 Million in the Coverage Gap
Distribution By Geographic Region: Distribution By State:
• Will more states adopt the Medicaid expansion? – Will more states submit waivers to implement the expansion?
• What will the effects of the Medicaid expansion be on the uninsured, state budgets overall, state economies and providers?
• What will we learn from current expansion waivers? – Effects on beneficiaries in terms of access to care and outcomes– Ability of states to administer and the federal government to track complex waiver
programs
• How will Medicaid costs and coverage growth compare in expansion and non-expansion states going forward?
• How will individuals in the coverage gap fare?
Looking Ahead
Q&A Discussion
Chris Lee, Senior Communications OfficerKaiser Family Foundation | Washington, D.C.Email: [email protected]
Contact Information
• NEW: An Overview of Actions Taken by State Lawmakers Regarding the Medicaid Expansion
• NEW: Are Uninsured Adults Who Could Gain Medicaid Coverage Working?
• UPDATED: The ACA and Medicaid Expansion Waivers
• Current Status of State Medicaid Expansion Decisions
kff.org/medicaid
Relevant Resources from KFF
Until next time, keep up with the Kaiser Family Foundation online:
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Email Alerts: kff.org/email
Thank you!