Medicaid

CSG Midwest
An extensive new report from the Kaiser Family Foundation, “Medicaid Moving Ahead in Uncertain Times: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2017 and 2018,” provides an overview of states’ approaches to eligibility, premiums and managed care initiatives, emerging delivery system and payment reforms, long-term services and support reform, and provider rates and taxes.

On Tuesday, Nov. 7, Maine voters approved (59 percent of the vote) a ballot measure to expand Medicaid eligibility to an estimated 70,000 low-income individuals. Maine is the first state to approve Medicaid expansion through a voter referendum. It would bring the expansion total to 32 states and the District of Columbia.

Gov. Paul LePage, who has vetoed Medicaid expansion bills five times, has issued a statement saying he will not implement the measure unless the legislature fully funds it.

Today Seema Verma, administrator for the Centers for Medicare and Medicaid Services (CMS), spoke to the state Medicaid directors at their fall conference in Washington, D.C. She outlined her vision for the future of Medicaid and unveiled a number of new CMS policies during that speech and in this press release. She pledged to give states more freedom to design innovative programs and to remove federal impediments that stand in the way of states.

Maine voters will have a chance to vote on Nov. 7, 2017, whether to expand Medicaid coverage to an estimated 70,000 Mainers under the age of 65 with incomes below or equal to 138 percent of the federal poverty level. This is exactly the Medicaid expansion provision included in the Affordable Care Act.

In Virginia, the November ballot impact on health care is a little less direct, but is also being watched by political observers. All 100 House of Delegate seats are up for election. If the Democrats pick up a number of seats the legislature could approve Medicaid expansion, bringing health care insurance to 400,000 low income Virginians.

Remember that after the Affordable Care Act passed, numerous commentators predicted that increased insurance coverage, achieved through purchase of individual plans through the ACA marketplace or expanded Medicaid coverage, would precipitate a primary care shortage? Experts feared that those with new coverage would not actually have access to care and those previously insured might experience decreased access to primary care. Studies have shown that primary care availability hasn’t suffered as expected.

Remember that after the Affordable Care Act passed, numerous commentators predicted that increased insurance coverage, achieved through purchase of individual plans through the ACA marketplace or expanded Medicaid coverage, would precipitate a primary care shortage? Experts feared that those with new coverage would not actually have access to care and those previously insured might experience decreased access to primary care. Studies have shown that primary care availability hasn’t suffered as expected.

The bill proposed this week by Senators Graham and Cassidy would repeal many provisions of the  Affordable Care Act and redesign the Medicaid program. Through 2026 the federal government would  provide each state a block grant in lieu of funding for Medicaid expansion and subsidies for health insurance purchased through the ACA marketplaces. Federal funding for Medicaid, absent the expansion, would be converted to a per capita cap basis, reducing federal expenditures over time. After 2026, the block grant would disappear. The bill would also eliminate consumer insurance protections of the ACA including prohibitions against annual and lifetime limits and underwriting practices related to pre-existing conditions.  

In Washington, the philosophical and political questions about the future of health care in the U.S. are swirling. A House bill to repeal and replace the Affordable Care Act and change Medicaid financing was considered early in 2017 and failed. Notably absent from the debate surrounding this bill was how to fix the underlying cost drivers of health care. If and when other proposals are considered, the question of cost drivers will likely be absent from those debates as well. The action to tackle affordability is in the states. Medicaid directors are transforming the way health care is paid for and delivered to contain costs and improve health outcomes. This transformation is taking place in partnership with consumers, providers and other payers.

Proceedings of the Medicaid 201 Leadership Policy Academy, Sept. 13-15, 2017

 

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CSG South

A vital tool for policymakers across the region, Comparative Data Reports (CDRs) offer a snapshot of conditions on a number of issues. Published annually, the CDRs track a multitude of revenue sources, appropriations levels, and performance measures in Southern states, and provide a useful tool to state government officials and staff.

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