#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...

As health care costs continue to rise and the future of the federal government’s Medicaid matching formula is made uncertain by the upcoming election, states are looking for innovative ways to improve health care outcomes while controlling costs. Possible solutions and promising programs were presented at the Getting More Bang for the Buck session Dec. 11 at the 2015 CSG National Conference.

Medicare pays between $16,500 and $33,000 for hip or knee replacements depending upon the hospital and geographic area of the country, but with a new payment program Medicare expects to save $343 over the next five years.

On Nov. 16, 2015, the Centers for Medicare & Medicaid Services announced they would begin to make bundled payments for these surgeries in 800 hospitals in 67 geographic areas under a model program over the next five years.

A ballot initiative to establish a single-payer health care system in Colorado has been approved for the Nov. 2016 ballot. Supporters turned in 158,831 signatures and after reviewing a five percent sample, the secretary of state’s office certified Initiative 20, the “State Health Care System.”

Last week Pennsylvania and Delaware moved toward a Plan B in case the Supreme Court rules against the Obama administration in the pending King v. Burwell lawsuit that questions whether tax subsidies can be provided in those states that did not opt to operate their own state health exchanges.

Depending on how the Supreme Court rules in King v. Burwell this summer, eight million residents of states now using the healthcare.gov exchange may lose federal insurance subsidies unless their state creates its own exchange. Some existing state exchanges have struggled with implementation over the last year. Others have been more successful.

During a CSG-East webinar on May 20th, Peter VanLoon, from Connecticut’s health insurance exchange, will describe how Access Health CT avoided most problems. Building on its success, Access Health CT is offering technical assistance and business services to states wishing to create or enhance their state-based exchange.

Increasing health care expenditures are a source of great worry to public officials. Perhaps new data that show that public programs – Medicare and Medicaid – seem to hold down per capita spending growth more than private insurance will provide some reassurance to officials as they consider expanding public programs in their states.

California voters rejected by a nearly 60 percent majority Proposition 45 that would have required the state insurance commissioner to approve proposed increases in health insurance rates for small groups and individuals.

WASHINGTON, D.C.—State Medicaid programs increasingly are depending on managed care arrangements, Julia Paradise, associate director of the Kaiser Commission on Medicaid and the Uninsured, told state legislators attending the CSG Medicaid Leadership Policy Academy in Washington, D.C., Sept. 15-17. “States see managed care as a strategy to extract savings,” she said.

The federal government has approved a Medicare waiver for Maryland intended to reduce hospital spending, Stateline reports today. Maryland is already the only state to set uniform prices for all hospitals. The same medical procedure costs the same in every hospital in the state regardless of the insurer, including Medicare and Medicaid. This has been true since 1974.

The Medicare waiver is how Maryland can set Medicare hospital rates – otherwise it would be subject to federal rules on rates. If the waiver succeeds in holding down costs, Maryland will continue to set its own Medicare hospital rates, currently higher than those in other states.

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