Medicaid Shift: The Impact of Coverage Expansion
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$1 in $6 Total U.S. Healthcare Spending Medicaid Spending of all healthcare spending in the United States Medicaid accounts for 5,220,000 Children 8,748,000 Adults 13,968,000 Number of Newly Eligible Medicaid Recipients Under the ACA 2013 Growth Rate 2.5 % lowest growth rate in 6 years Projected 2014 Growth Rate 8.8 % average across all states 40 states in 2013 44 states in 2014 39 states in 2013 34 states in 2014 adopted provider rate increases reported provider rate restrictions Rate Increases Rate Restrictions Medicaid Shift: The Impact of Coverage Expansion Overview The implementation of the Affordable Care Act (ACA), as well as an array of recently developed delivery and payment system reforms, has been and will continue to transform Medicaid. These policies have generated some of the most significant changes to Medicaid since its enactment in 1965 and are impacting the role of Medicaid in the healthcare system in every state. Under the ACA, Medicaid plays a key role in efforts to reduce the number of uninsured. Eligibility is expanded to nearly all low-income adults with earnings at or below 138 percent of the federal poverty level ($16,105 per year for an individual in 2014). However, the Supreme Court ruling on the ACA effectively made the expansion an optional, state-by-state decision. As of January 2014, 24 states and the District of Columbia were implementing the expansion; the remaining 26 states are not moving forward with Medicaid expansion at this time. Today, Medicaid provides health and long-term care coverage to more than 66 million low-income Americans. Medicaid accounts for $1 in $6 of all healthcare spending in the United States but is the primary payer for long-term care services and support, as well as a major source of revenue for safety-net providers. Medicaid also provides assistance for over 9.5 million dual eligibles. Dual eligibles are covered by both Medicare and Medicaid and include low-income seniors and younger people with disabilities. These dual eligible beneficiaries have complex and often costly healthcare needs and have been the focus of many recent initiatives and proposals aimed at both raising the quality of their care and reducing its costs. The implementation of the ACA will result in major changes to Medicaid eligibility and enrollment for all states, whether they are implementing the ACA Medicaid expansion or not. Enrollment Trends in 2014 In 2014, national enrollment and spending growth are expected to rise. States moving forward with Medicaid expansion are expected to see higher enrollment and total spending growth driven by increases in coverage and federal funds. • In 2013, Medicaid enrollment growth slowed to 2.5 percent, the lowest rate of growth in 6 years. • Enrollment growth for 2014 is projected to average 8.8 percent across all states. • The difference reflects the cost of covering newly eligible enrollees, who qualify for 100 percent federal funding. • In 2013 and 2014, state Medicaid programs focused their attention on delivery system and payment reform designed to improve quality and minimize unnecessary costs. • Thirty-nine states reported a policy change or initiative to expand managed care or improve care through a managed care-focused quality initiative. • Outside of managed care, new or expanded care coordination efforts were underway in 40 states, including health homes, patient-centered medical homes (PCMHs), and Accountable Care Organizations (ACOs). • Developing integrated, coordinated systems of care to serve dual eligible beneficiaries continues to be an area of focus for states. In 2014, a total of 14 states reported plans to implement a formal demonstration project. © 2014 Verisk Health Take a closer look at how Verisk Health is working with Medicaid plans to improve quality, pay claims accurately, and manage their populations at: The Coverage Gap In states that are not expanding Medicaid under the ACA, there will be large gaps in coverage for adults. As of January 2014, the median eligibility level for parents in states not moving forward is just 46 percent of the federal poverty level, or about $9,000 per year for a family of three. Economic improvements have enabled states to focus attention on program restorations and increases in provider rates and benefits, but states have also adopted policies to control costs and enhance program integrity. Looking Ahead 2014 will continue to be a transformative year for Medicaid. The scope and volume of change related to the implementation of the ACA and payment and delivery system reforms, as well as efforts to control costs, create enormous opportunities and challenges. Notwithstanding intense challenges, Medicaid faces new opportunities to make improvements in program administration that underpin improvements in delivery systems, quality, outcomes, and coverage. More than one fifth (22 percent) of individuals in the U.S. coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility. Sixteen percent live in Florida, 9 percent live in Georgia, 7 percent live in North Carolina, and 6 percent live in Pennsylvania. Nationally, 86 percent of poor uninsured adults in states not expanding are ineligible for Medicaid. The share of poor uninsured adults in the gap ranges from a high of 91 percent in Idaho, North Carolina, and Texas, to 67 percent in Alaska. 45 states reported eligibility and enrollment expansions and enhancements for 2014. 24 states adopted the Medicaid expansion for nearly all low-income Americans with earnings up to 138 percent of the federal poverty level. 8 states reported plans to implement eligibility expansions aside from the ACA Medicaid expansion. 38 states reported changes to enrollment processes beyond the ACA-required changes. The large majority of these changes were tied to states adopting new options to streamline enrollment. 12 states are implementing Medicaid eligibility restrictions in 2014. These cuts are targeted to nondisabled adults, most of whom will be able to obtain subsidies to purchase coverage in the new marketplaces. Nearly 5 million poor uninsured adults will fall into the “coverage gap” that results from state decisions not to expand Medicaid, meaning that their income is above current Medicaid eligibility but below the lower limit for marketplace premium tax credits. Covered with Medicaid No Coverage Marketplace Subsidies Pennsylvania 6% North Carolina 7% Georgia 9% Florida 16% Texas 22% Other States 41% www.veriskhealth.com/managedcare states reported plans to implement a formal demonstration project to serve dual eligibles states reported that coordination efforts were underway states reported a policy change or initiative with a managed-care focus Nearly all states are developing and implementing payment and delivery system reforms designed to improve quality, manage costs, and better balance the delivery of long-term services and support across institutional and community-based settings. Source: Kaiser Family Foundation
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The implementation of the Affordable Care Act (ACA), as well as an array of recently developed delivery and payment system reforms, has been and will continue to transform Medicaid. These policies have generated some of the most significant changes to Medicaid since its enactment in 1965 and are impacting the role of Medicaid in the healthcare system in every state.
Transcript of Medicaid Shift: The Impact of Coverage Expansion
$1 in $6
Tota
l U.S
. Hea
lthca
re S
pend
ing
Medicaid S
pending
of all healthcare spending in the United StatesMedicaid
accounts for
5,220,000Children
8,748,000 Adults
13,968,000Number of Newly Eligible Medicaid
Recipients Under the ACA
2013 Growth Rate
2.5%lowest growth ratein 6 years
Projected 2014 Growth Rate
8.8%average across all states
40states in 2013
44states in 2014
39states in 2013
34states in 2014
adopted provider rate increases reported provider rate restrictions
RateIncreases
RateRestrictions
Medicaid Shift:The Impact of Coverage Expansion
Overview
The implementation of the Affordable Care Act (ACA), as well as an array of recently developed delivery and
payment system reforms, has been and will continue to transform Medicaid. These policies have generated
some of the most significant changes to Medicaid since its enactment in 1965 and are impacting the role of
Medicaid in the healthcare system in every state.
Under the ACA, Medicaid plays a key role in efforts to
reduce the number of uninsured. Eligibility is expanded to
nearly all low-income adults with earnings at or below 138
percent of the federal poverty level ($16,105 per year for
an individual in 2014). However, the Supreme Court ruling
on the ACA effectively made the expansion an optional,
state-by-state decision. As of January 2014, 24 states and
the District of Columbia were implementing the expansion;
the remaining 26 states are not moving forward with
Medicaid expansion at this time.
Today, Medicaid provides health and long-term care coverage to more
than 66 million low-income Americans.
Medicaid accounts for $1 in $6 of all healthcare spending in the United
States but is the primary payer for long-term care services and
support, as well as a major source of revenue for safety-net providers.
Medicaid also provides assistance for over 9.5 million dual eligibles.
Dual eligibles are covered by both Medicare and Medicaid and include
low-income seniors and younger people with disabilities. These dual
eligible beneficiaries have complex and often costly healthcare needs
and have been the focus of many recent initiatives and proposals
aimed at both raising the quality of their care and reducing its costs.
The implementation of the ACA will result in major changes to Medicaid eligibility and enrollment for all states, whether they are implementing the ACA Medicaid expansion or not.
Enrollment Trends in 2014In 2014, national enrollment and spending growth are expected to
rise. States moving forward with Medicaid expansion are expected
to see higher enrollment and total spending growth driven by
increases in coverage and federal funds.
• In 2013, Medicaid enrollment growth slowed to 2.5
percent, the lowest rate of growth in 6 years.
• Enrollment growth for 2014 is projected to average
8.8 percent across all states.
• The difference reflects the cost of covering newly eligible
enrollees, who qualify for 100 percent federal funding.
• In 2013 and 2014, state Medicaid programs focused their
attention on delivery system and payment reform designed
to improve quality and minimize unnecessary costs.
• Thirty-nine states reported a policy change or initiative to
expand managed care or improve care through a
managed care-focused quality initiative.
• Outside of managed care, new or expanded care
coordination efforts were underway in 40 states, including
health homes, patient-centered medical homes (PCMHs),
and Accountable Care Organizations (ACOs).
• Developing integrated, coordinated systems of care to
serve dual eligible beneficiaries continues to be an area of
focus for states. In 2014, a total of 14 states reported plans
to implement a formal demonstration project.
© 2014 Verisk Health
Take a closer look at how Verisk Health is working with Medicaid plans to improve quality, pay claims accurately, and manage their populations at:
The Coverage GapIn states that are not expanding Medicaid under the ACA, there will be large gaps in coverage for adults.
As of January 2014, the median eligibility level for parents in states not moving forward is just 46 percent of
the federal poverty level, or about $9,000 per year for a family of three.
Economic improvements
have enabled states to
focus attention on
program restorations and
increases in provider rates
and benefits, but states
have also adopted policies
to control costs and
enhance program integrity.
Looking Ahead2014 will continue to be a transformative year for Medicaid. The scope and volume of change related to
the implementation of the ACA and payment and delivery system reforms, as well as efforts to control
costs, create enormous opportunities and challenges.
Notwithstanding intense challenges, Medicaid faces new opportunities to make improvements in program
administration that underpin improvements in delivery systems, quality, outcomes, and coverage.
More than one fifth (22 percent) of individuals in the U.S.
coverage gap reside in Texas, which has both a large uninsured
population and very limited Medicaid eligibility. Sixteen percent
live in Florida, 9 percent live in Georgia, 7 percent live in North
Carolina, and 6 percent live in Pennsylvania.
Nationally, 86 percent of poor uninsured adults in states not
expanding are ineligible for Medicaid. The share of poor
uninsured adults in the gap ranges from a high of 91 percent in
Idaho, North Carolina, and Texas, to 67 percent in Alaska.
45states reported
eligibility and
enrollment
expansions and
enhancements for
2014.
24states adopted the
Medicaid expansion
for nearly all
low-income
Americans with
earnings up to 138
percent of the federal
poverty level.
8states reported plans
to implement
eligibility expansions
aside from the ACA
Medicaid expansion.
38states reported changes to
enrollment processes
beyond the ACA-required
changes. The large majority
of these changes were tied
to states adopting new
options to streamline
enrollment.
12states are implementing
Medicaid eligibility
restrictions in 2014.
These cuts are targeted
to nondisabled adults,
most of whom will be
able to obtain subsidies
to purchase coverage in
the new marketplaces.
Nearly 5 million poor uninsured adults will fall into the “coverage gap” that results from state decisions not to expand Medicaid,
meaning that their income is above current Medicaid eligibility but below the lower limit for marketplace premium tax credits.
Covered withMedicaid
NoCoverage
MarketplaceSubsidies
Pennsylvania
6%North Carolina
7%
Georgia
9%
Florida
16%
Texas
22%
Other States
41%
www.veriskhealth.com/managedcare
states reported plans to
implement a formal
demonstration project to
serve dual eligibles
states reported that
coordination efforts
were underway
states reported a policy
change or initiative with a
managed-care focus
Nearly all states are developing and implementing payment and delivery system reforms
designed to improve quality, manage costs, and better balance the delivery of long-term
services and support across institutional and community-based settings.
Source: Kaiser Family Foundation
