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Medicaid and the ACA: Issues for Reporters
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Transcript of Medicaid and the ACA: Issues for Reporters
Medicaid and the ACA:
Issues for Reporters
Reporting on HealthMarch 5, 2013
Alan WeilExecutive DirectorNational Academy for State Health Policy
What We Will Discuss
• How the ACA affects Medicaid
• The Medicaid expansion
• Medicaid beyond the expansion
• Medicaid’s relationship to the health
insurance exchange
• The remaining uninsured
Health Reform & Medicaid• Expands for adults to 133% of the federal poverty level
without regard to family structure or assets as of January
1, 2014
• Maintains children’s CHIP and Medicaid eligibility levels
through 2019
• Option for benchmark benefit package based on
essential health benefits package for new adults
• Full federal funding for individuals newly eligible for
Medicaid for 2014-2016, phasing down to 90% in 2020
and beyond
• Supreme Court rules federal government cannot
penalize states that decline to expand
Source: Kaiser Family Foundation, “Medicaid and Children’s Health Insurance Program Provisions in the New Health Reform Law”, April 2010
Four Perspectives
on the Medicaid Expansion
• Coverage
• Cost
• Health
• Health system performance
24%41%
73%
90%34%
23%
9%42% 37%
19%6%4%
<100% FPL 100-199% FPL 200-399% FPL 400%+ FPL
Employer/Other Private Medicaid/Other Public Uninsured
FPL= Federal Poverty Level. The FPL was $22,250 for a family of four in 2011. Data may not total 100% due to rounding. SOURCE: KCMU/Urban Institute analysis of 2012 ASEC Supplement to the CPS.
Health Insurance Coverage of the Nonelderly by Poverty Level, 2011
Who Are the Currently Uninsured?
Who Gets Covered by Expansion?
• Medicaid in 2022:
– 52.4 million enrolled if no ACA
– 58.1 million enrolled with ACA and no states
electing expansion
– 73.7 million enrolled with ACA and all states
electing expansion
SOURCE: Holahan, John; Buettgens, Matthew; Caroll, Caitlin; Dorn, Stan. Urban Institute for the Kaiser Commission on Medicaid and the Uninsured. The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis.
How Big a Reduction in Uninsured?
With all states expanding, the number of
uninsured in the US is estimated to be
27.9 million in 2022, while it would have
been 53.3 million without the ACA. This
amounts to a 47.6% reduction in the
uninsured.
SOURCE: Holahan, John; Buettgens, Matthew; Caroll, Caitlin; Dorn, Stan. Urban Institute for the Kaiser Commission on Medicaid and the Uninsured. The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis.
8
SOURCE: Sommers BD, Baicker K, Epstein AM. Mortality and access to care among adults after state medicaidexpansions. N Engl J Med 2012;367:1025–34.
Unadjusted Mortality and Rates of Medicaid Coverage
among Nonelderly Adults before and after State Medicaid
Expansions (1997–2007).
Medicaid and Health System
Performance
• Coverage continuity
• Care continuity
• Aligned quality metrics
• Aligned purchasing and reporting
strategies
SOURCE: The Advisory Board Company. Where each state stands on the ACA’s Medicaid expansion. Accessed February 27, 2013 at http://www.advisory.com/Daily-Briefing/2012/11/09/MedicaidMap#lightbox/0/.
SOURCE: State Reforum: Tracking Medicaid Expansion Decisions. Accessed February 27, 2013 at http://www.statereforum.org/medicaid-expansion-decisions
Medicaid Beyond the Expansion
• Eligibility and enrollment systems
• Dual eligible demonstrations
• Health homes
• Reductions in Safety Net Hospital funding
(DSH)
Eligibility System UpgradesState Responses Regarding Streamlined Eligibility and Enrollment Requirements
SOURCE: Department of Health and Human Services. Office of the Inspector General. Most States Anticipated Implementing Streamlined Eligibility and Enrollment by 2014. February 2013. Accessed Feb 28, 2013 at https://oig.hhs.gov/oei/reports/oei-07-10-00530.pdf
Duals Demonstration States
SOURCE: Kaiser Family Foundation. State Adoption of Integrated Financing and Care Delivery for Dually Eligible Beneficiaries Provided by the Affordable Care Act, August 2012. Accessed Feb 28, 2013 at http://statehealthfacts.kff.org/comparemaptable.jsp?ind=1067&cat=17
Section 2703 Health Home Activity
WA
TX
NC
LA
PA
NY
IA
VA
NE
OK
RI
AL
MD
MT
ID
KS
MN NH
MA
ME
AZ
VT
MOCA
WY
NM
IL
WI
MI
WV
SC
GA
FLHI
NV
ND
SD
AR
IN
KY
TN
MS
AK
DE
CTNJ
16
Approved (12 SPAs in 8 States)
Submitted (4 States)
Planning Grant (16 States and D.C.)
DC
As of December 2012
OR
UTCO
OH
Cuts in Medicaid Safety Net Funds
SOURCE: Mitchell A. Congressional Research Service. Medicaid Disproportionate Share Hospital Payments. Washington (DC): CRS; 2012 Dec 18. Available from:https://www.fas.org/sgp/crs/misc/R42865.pdf
Total DSH Allotments Before the Reductions, with the ACA Reductions, and Under Current Law ($ in billions)
Churn between Medicaid and the Health
Insurance Exchanges
SOURCE: Sommers BD, Rosenbaum S. Issues In Health Reform: How Changes In Eligibility May Move Millions Back and Forth Between Medicaid And Insurance Exchanges. Health Affairs, February 2011, vol 30, no 2, pgs 228-236.
Income Changes Over Time Among Adults Aged 19-60 With Incomes Initially Between 133 Percent and 200 Percent Of The Federal Poverty Level
The Remaining UninsuredDistribution of Nonelderly Uninsured Adults Under the ACA
SOURCE: Buettgens M, Hall MA. The Urban Institute. Who Will Be Uninsured After Health Insurance Reform? Accessed Feb 28, 2013 at http://www.urban.org/UploadedPDF/1001520-Uninsured-After-Health-Insurance-Reform.pdf
Statereforum.org is a space for…
• Peer-to-peer learning and discussion
• Exchanging reform ideas
• Posting, organizing, and sharing useful state documents
• Announcing off-line events and activities
• Spotlighting the keys to successful implementation
• Mapping states’ progress in implementing health reform
Alan Weil
Executive Director
www.nashp.org
www.nashp.org/onceinaweil
www.statereforum.com
@nashphealth