Medicaid in a historic time of transformation: results from a 50-state Medicaid budget survey for state fiscal years 2013 and 2014
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (Henry J. Kaiser Family Foundation)
- Author(s):
- Smith, Vernon K., author Gifford, Kathleen, author Ellis, Eileen, author Rudowitz, Robin, author Snyder, Laura, author
- Contributor(s):
- Henry J. Kaiser Family Foundation, issuing body. Kaiser Commission on Medicaid and the Uninsured, issuing body.
- Publication:
- Menlo Park, CA : Kaiser Commission on Medicaid and the Uninsured, Henry J. Kaiser Family Foundation, October 2013
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Budgets -- trends Health Policy -- trends Insurance Coverage -- economics Insurance Coverage -- trends Medicaid -- economics Medicaid -- trends United States United States.
- Genre(s):
- Technical Report
- Abstract:
- The dominant forces shaping Medicaid during FY 2013 and heading into FY 2014 were the implementation of the Affordable Care Act (ACA) and the development and implementation of an array of delivery and payment system reforms. These changes represent some of the most significant changes to Medicaid since its enactment in 1965, and taken together, are transforming the role of Medicaid in the health care system in each state. At this time, the intensity of fiscal pressures and the focus on Medicaid cost containment were somewhat lessened as the economy slowly recovers; however, controlling costs and improving program administration are still important priorities for Medicaid program. (ES-1). Today, Medicaid provides health and long-term care coverage to more than 66 million low-income Americans. Medicaid accounts for one in six dollars of all health care spending in the US but is the primary payer for long-term care services and supports (LTSS) and a major source of revenue for safety-net providers. Medicaid provides assistance for over 9.5 million low-income Medicare beneficiaries. The program continues to evolve as states implement programs to improve care, manage costs and improve quality using managed care as well as other care coordination initiatives. As enacted in the ACA, Medicaid's role was broadened to become the foundation of coverage for nearly all low-income Americans with incomes up to 138 percent of the federal poverty level (FPL) ($15,856 per year for an individual in 2013). However, the Supreme Court ruling on the ACA effectively made the decision to implement the Medicaid expansion an option for states. Twenty-five states (including the District of Columbia) have announced plans to move forward with the expansion; the remaining 26 states are not moving forward with the Medicaid expansion at this time. (ES-2) State decisions about implementing the Medicaid expansion have important coverage and fiscal consequences for states. In states that do not expand Medicaid, adults may face large gaps in coverage. M The findings in this report are drawn from the 13th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA). The report highlights trends in Medicaid spending, enrollment and policy initiatives for FY 2013 and FY 2014 with an intense focus on eligibility and enrollment changes tied to the implementation of the ACA as well as payment and delivery system changes. The report provides detailed appendices with state-by-state information and a more in-depth look at four case study states: Arizona, Florida, Kentucky and Washington. Key findings from the survey include the following: (1) Improvements in the economy resulted in modest growth in Medicaid spending and enrollment in FY 2013. In FY 2014, national enrollment and spending growth are expected to rise. States moving forward with the Medicaid expansion are expected to see higher enrollment and total spending growth driven by increases in coverage and federal funds. (2) 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. (3) 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 supports across institutional and community-based settings. (4) Improvements in the economy have enabled states to implement more program restorations or improvements in provider rates and benefits compared to restrictions, but states also adopted policies to control costs and enhance program integrity. (5) Looking ahead, FY 2014 will be a transformative year for Medicaid.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (132 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101619763 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101619763