Medicaid and the ACA: Issues for Reporters

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Medicaid and the ACA: Issues for Reporters Reporting on Health March 5, 2013 Alan Weil Executive Director National Academy for State Health Policy

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Alan Weil Executive Director National Academy for State Health Policy

Transcript of Medicaid and the ACA: Issues for Reporters

Page 1: 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

Page 2: Medicaid and the ACA: Issues for Reporters

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

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Health Reform & Medicaid• Maintains children’s CHIP and Medicaid eligibility

levels through 2019; adults through 2013• Expands for adults to 133% of the federal poverty

level without regard to family structure or assets as of January 1, 2014

• 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

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Four Perspectives on the Medicaid Expansion

• Coverage• Cost• Health• Health system performance

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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?

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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.

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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.

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SOURCE: Sommers BD, Baicker K, Epstein AM. Mortality and access to care among adults after state medicaid expansions. 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).

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Medicaid and Health System Performance

• Coverage continuity• Care continuity• Aligned quality metrics• Aligned purchasing and reporting

strategies

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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/.

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SOURCE: State Reforum: Tracking Medicaid Expansion Decisions. Accessed February 27, 2013 at http://www.statereforum.org/medicaid-expansion-decisions

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Medicaid Beyond the Expansion

• Eligibility and enrollment systems• Dual eligible demonstrations• Health homes• Reductions in Safety Net Hospital

funding (DSH)

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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

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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

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Section 2703 Health Home Activity

WA

TX

NC

LA

PA

NY

IA

VA

NE

OK

RI

AL

MD

MT

ID

KS

MN NHMA

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

UT CO

OH

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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)

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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

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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

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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