CSG Midwest

Under managed care, states do not pay health care providers on a fee-for-service basis. Instead, MCOs are paid an agreed-upon amount for each member’s health care expenses. Adjustments can be made to the per-member fee based on the health status of the member. Savings are shared between the states and the MCO, the latter of which assumes the risk of cost overruns.

Iowa began its journey to...

Despite pushing the federal government to provide 100 percent of the cost for health care for American Indians, what South Dakota Gov. Daugaard has characterized as a longstanding treaty obligation, on Feb. 29 Daugaard ruled out Medicaid expansion during this legislative session.

Last week, two states rejected Medicaid expansion, another is continuing negotiations with Washington and one is studying whether and how to continue expansion already in place and reduce the numbers of people eligible. Currently 31 states and the District of Columbia have expanded income eligibility for Medicaid as provided for by the Affordable Care Act. Sixteen states remain firmly in the non-expansion column.

On Tuesday, Jan. 12, John Bel Edwards signed his first executive order as Louisiana’s new governor to expand Medicaid eligibility to an estimated 300,000 individuals. The expansion is to be effective no later than July 1, 2016 according to the order.

Louisiana becomes the 31st state (plus DC) to expand Medicaid income eligibility as permitted by the Affordable Care Act.

South Dakota Gov. Dennis Daugaard may find that the third time is the charm as he negotiates with the federal government to live up to its treaty obligations to provide health services to the state’s Native Americans. Twice before in recent state history, governors have tried and failed to solve the longstanding problem, which results in a massive cost shift to state revenues to pay for health care for many Native Americans. In his Dec. 8, 2015, budget address in Pierre, S.D., Daugaard proposed that should the federal government fulfill its obligation to provide health services to Native Americans, the state would use the projected $67 million annual savings to the state to finance the cost of Medicaid expansion.

CSG Director of Health Policy Debra Miller outlines the top five issues in health policy for 2016, including Medicaid expansion, substance abuse and drug overdoses, cost containment, the graying of America, and population health. 

#1  Medicaid Expansion

Thirty states and the District of Columbia have expanded Medicaid eligibility to 138 percent of the federal poverty level as allowed by the Affordable Care Act, and they will be required to contribute matching funds beginning Jan. 1, 2017. This means that legislatures in those states will have to appropriate state funds during their budget sessions in 2016.  

The federal funding will decrease from covering 100 percent of the newly eligible...

CSG Director of Fiscal and Economic Development Policy Jennifer Burnett outlines the top five issues for 2016, including strategic decisions following modest revenue growth, workforce development, public pensions, federal instability, and health care costs. 

No state can ignore the challenge of controlling the cost of health care, estimated to reach one-fifth of GDP by 2020. Medicaid budget growth continues to strain states’ abilities to grow program priorities in other arenas. The uncertainty of federal commitment to current Medicaid matching formulas is exacerbated by the 2016 election. Promising state strategies to control costs of health care generally and Medicaid specifically were explored.

No state can ignore the challenge of controlling the cost of health care, estimated to reach one-fifth of GDP by 2020. Medicaid budget growth continues to strain states’ abilities to grow program priorities in other arenas. The uncertainty of federal commitment to current Medicaid matching formulas is exacerbated by the 2016 election. Promising state strategies to control costs of health care generally and Medicaid specifically were explored.  

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