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Medicaid Coverage Gap Resources

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Medicaid Coverage Gap Resources

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Commentary

This commentary tells the story of Danielle, whose small business struggled in the opening months of the COVID-19 pandemic. In addition to trying to keep her business afloat, Danielle also had to care for her son and home school him. Medicaid provided Daneille with the mental health support needed to keep moving forward during an incredibly challenging period. 

That’s Medicaid shares stories of people covered by Medicaid at critical points in their lives, underscoring the importance of stable health insurance coverage to building a nationwide Culture of Health.

Blog

This blog explores how states can coordinate and prepare communications related to the end of the Medicaid continuous coverage requirement with clear messaging to inform enrollees, help to reduce churn, and maximize coverage renewal, retention, and transition.

Report

This report provides excerpts of health disparities and health equity language from Medicaid managed care (MMC) contracts and requests for proposals (RFPs) from 17 states and the District of Columbia. The criteria for inclusion in this compendium are contracts and RFPs that explicitly address health disparities and/or health equity.

Blog

Amid rising healthcare costs, this blog explores how a public coverage option in the individual and small group Marketplace could help reduce costs and expand access to coverage for people with job-based insurance.

Commentary

This commentary tells the story of Adrian, who works with the Medicaid-funded Mississippi Youth Programs Around the Clock program. Adrian's work provides youth and their families with needed "wraparound" services to cultivate healthier communities.

That’s Medicaid shares stories of people covered by Medicaid at critical points in their lives, underscoring the importance of stable health insurance coverage to building a nationwide Culture of Health.

Blog

With new budget initiatives, a California Momnibus Act, and a new Medicaid transformation initiative, the state is seeking to advance more whole-person care for pregnant and birthing people, and to ensure and expand access to reproductive health care, including abortion services.

Commentary

This commentary tells the story of Sonia who took on the life-changing responsibility of adopting a family member’s young son Amir, who has developmental disabilities. Medicaid provided Amir with preventive doctor visits, X-rays, and speech and occupational therapy.

Blog

With the premium tax credit expansion’s (PTC) sunset approaching, Congress has been considering passing an extension—first in the Build Back Better Act and more recently for potential inclusion in narrower reconciliation legislation. This blog explores cost and enrollment rates without an extension of the ARPA’s expanded PTC.

Commentary

This commentary tells the story of Naomi who enrolled in Medicaid after she lost her job when pregnant with her son, who was born prematurely. Medicaid provided in-home attendants, a wheelchair, medications and other necessities to help improve her son's quality of life.

Commentary

This commentary tells the story of Regina, who is able to help provide her daughter with physicals, immunizations, dental visits and medication—which the family couldn’t obtain without Medicaid coverage.

Commentary

This commentary tell the story of how Nancy, with the assistance of Medicaid, was able to receive the care she needed and was even inspired to study medical billing when she goes to college.

Blog

This blog examines the landscape of marketplace race and ethnicity data and detail strategies state-based marketplaces can implement for the upcoming open enrollment period to improve data collection.

Podcast

The podcast episode features Medicaid leaders discussing the need for agency leadership to engage in self-observation and recognize bias when committing to advance equity within their agencies and for enrollees.

Resource Page, Webinar & Presentations

The webinar aimed to bring together those in states who have implemented social risk factor screening measures for incentive use in managed care contracts.

Blog

This blog explores how states can use Medicaid data to quantify tobacco use within this population, identify related best practices, and make recommendations for scaling.

Report

This report examines the cost and coverage effects of lowering the age of Medicare eligibility from 65 to 60.

This blog explores the 1902(e)(14) waiver to help support states in their efforts to successfully “unwind” from the Medicaid continuous coverage requirement.

Brief

In this brief, researchers explore what will happen to healthcare spending if the American Rescue Plan Act Premium Tax Credits expire.

Resource Page

This toolkit contains a table that can be used by a state to examine current ex parte processes and identify and deploy additional strategies that could increase their ex parte rates.

Commentary

This commentary tells the story of Jasmine, a single mother and full-time day-care employee who was laid off after injuries she sustained in a fall that left her unable to work. With the help of the Medicaid program, she quickly got back on her feet and returned to work.

Blog

This blog, the first in a two-part series, outlines strategies state Medicaid agencies can take to identify people with high health needs and provide them with additional support to retain or transition their health coverage in order to maintain access to essential healthcare services. 

Blog

This blog analyzes the Centers for Medicare & Medicaid Services' final rules for provider network adequacy standards in the federal healthcare marketplaces and Medicaid.

Podcast

For years, Medicaid leaders have faced a mounting children’s behavioral health crisis — made worse by the pandemic. In this episode of the Medicaid Leadership Exchange podcast, three Medicaid leaders discuss the behavioral health needs of children and opportunities for Medicaid to better support those needs.

Commentary

This commentary tells the story of Theresa. At an early age, she was diagnosed with Spastic Quadriplegia Cerebral Palsy, a disorder that affects a person’s ability to maintain balance and posture. Now in her 40s, Medicaid allows her to work and live independently. It also provides her with speech, physical and occupational therapies, a wheelchair and the help of personal care attendants who assist with basic needs such as meal preparation, cleaning, dressing, and laundry.

Chart, Map

This map and chart highlight dental benefits for general adults and pregnant populations enrolled in Medicaid.  

Podcast

In this podcast, Medicaid Leadership Exchange, former Medicaid directors explore what they would prioritize now and into the future when the Medicaid public health emergency unwinds — and where blind spots may lie.

Commentary

This commentary tells the story of Sonia, whose adopted son has developmental disabilities and requires frequent medical testing to stay healthy.

Blog

In this Health Affairs blog post, Nancy Archibald, MHA, MBA, CHCS’ Associate Director for Federal Integrated Care Programs, outlines perspectives from state Medicaid officials on the federal policies that have advanced Medicare-Medicaid integration, and areas where they believe additional federal policy actions are needed.

Commentary

This commentary tells the story of Alicia, a pregnant woman looking for maternal support while incarcerated and pregnant with her second child. Thanks to Medicaid, she was assigned a doula who guided her through the rest of her pregnancy and the birth of her son.

Brief

This update to the methodology documentation for the Urban Institute’s Health Insurance Policy Simulation Model explains how they estimated health coverage in 2023, taking into account major uncertain issues such as Medicaid enrollment after the HHS public health emergency and the potential expiration of enhanced premium tax credits for Marketplace coverage in 2023.

Blog, Graphic

This blog post provide an analysis of the National Center for Health Statistics (NCHS) health insurance coverage estimates for 2021 from the National Health Interview Survey (NHIS) as part of the NHIS Early Release Program. The estimates captured in this report are some of the first available coverage estimates for 2021 from a federal survey.

Map

This interactive map and chart summarize proposed and approved legislation since 2018, Medicaid waivers, financial estimates, and other initiatives designed to extend coverage during the postpartum period. (Under the Families First Coronavirus Response Act, Medicaid enrollees who typically lose coverage after 60 days postpartum cannot be disenrolled until the end of the month in which the public emergency period ends.)

Blog

This blog provides updates focused on health insurance coverage, insurance markets, and how people are affected by insurance reform.

Resource Page

05.2022 / By Benefits Data Trust

This toolkit is designed to help state and local WIC agencies leverage data from Medicaid and SNAP to measure enrollment gaps and increase enrollment using tools to plan, launch, and/or strengthen data matching and targeted outreach to eligible families who are not receiving WIC benefits.

Brief

This brief presents benchmark premium data separated by urban versus rural rating regions and includes data on the differences between average benchmark premiums in 2019 and 2022 for all 50 states and the District of Columbia.

Blog

At the end of the Pubic Health Emergency, more than 15 million people may become uninsured if they cannot secure alternate sources of health coverage. This blog provides actions states should carefully consider to ensure that stakeholders, including insurers, are facilitating these critical transitions.

Blog

This blog explores how states can work with The Program of All Inclusive Care for the Elderly (PACE) and its organizations to provide a comprehensive, fully integrated package of Medicare and Medicaid services to elderly individuals who require a nursing home level of care.

Blog

This blog answers questions about the ACA's "family glitch," a flawed regulatory interpretation that has created barriers to coverage. The current administration is currently working to correct this interpretation that prevents 4.8 to 5 million individuals from accessing more affordable health insurance. 

Blog

This blog discuss the important role that ACA marketplaces will play in mitigating coverage losses as they prepare for the end of the Public Health Emergency and identifies basic as well as more innovative strategies marketplaces can adopt to help consumers make a smooth transition to affordable, comprehensive coverage.

Blog

05.2022 / By Benefits Data Trust

This blog explores how states are working to prepare for the end of the Public Health Emergency with the goal of modernizing benefits access to Medicaid, SNAP, and WIC rather than returning to pre-pandemic practices. 

Commentary

This commentary tells the story of Tania, a single mother of two who credits her experience as a Medicaid recipient for her journey into a new profession.

TOPICS
Resource Page

This toolkit highlights opportunities for states to leverage managed care plans to support unwinding the Medicaid continuous coverage requirement. 

Resource Page

This toolkit is intended to assist state officials in evaluating their current estate recovery policies and understanding where they may have flexibility to make the policies less burdensome for affected low-income families.

Chart

A cost-growth benchmark program is a cost-containment strategy that limits how much a state’s health care spending can grow each year. This chart provides a snapshot of programs across the country including state efforts to improve care quality and outcomes in the program.

Blog

This blog explores how Iowa Medicaid program implemented a town hall program that successfully integrates member and stakeholder perspectives into it's program and policy design.

Commentary

This commentary tells the story of Sabrina, who plans to become a doctor, and how her experience as a Medicaid recipient informed how she sees the U.S. health care system. 

Blog

This blog provides model comments developed to inform and support state responses to the Centers for Medicare & Medicaid Services' RFI to achieve substantial reforms on access to coverage–namely, the processes for enrollment and eligibility redeterminations.

Resource Page

This toolkit provides a communications planning guide designed to support state Medicaid agencies as they prepare for the upcoming end of the continuous coverage requirement.

Blog

This blog analyzes survey results on how many people in Minnesota have health insurance and how easy it is for them to get health care.

Report

This report summarizes the different elements of California’s initiative, which provides a model for other states seeking to expand housing services and whole person care through Medicaid.


Commentary

This commentary tells the story of Nicholas who requires some extra assistance with daily activities as a result of his autism. Medicaid helps afford all of his caretakers and provides him with transportation to and from his job as a COVID-19 front-line worker.

Map

This map provides eligibility levels for states’ Medicaid and Children’s Health Insurance Program coverage for pregnancy.

Blog

This blog, briefly reviews the research regarding the Medicaid undercount in the CPS, provides estimates of how it varies across states in 2020, and discusses the impact of assigning single coverage for those with multiple sources on the Medicaid undercount in the CPS.

Commentary

This commentary tells the story of Margot C., who has limited mobility due to rheumatoid arthritis, fibromyalgia, and a spinal cord injury. Medicaid provided her housing in a residential care setting that her private insurance could not provide. Now, Margot helps her peers sign up for Medicaid.

Blog

This blog summarizes the new reporting requirements and presents a set of considerations for states as they begin implementing new unwinding policies, procedures, and reporting.

Brief

This brief reviews the regulatory framework for network adequacy for Medicaid Managed Care Organizations and Marketplace qualified health plans and identifies policies and practices to ensure their networks include the number and mix of providers that enrollees need.

Commentary

This commentary tells the story of Maddy K., a 23-year-old who has Asperger syndrome who is able to work two part-time jobs, volunteer frequently, and be part of a community organization for those with disabilities because of Medicaid's ability to provide her with essential transportation.

Blog

This blog explores strategies on how to invest in the development of Medicaid leaders to help states and territories improve the health and well-being of people served by publicly financed care.

Key tips include:

Always have a plan b, plan c, and plan d.
Build relationships and find a common thread.
Fill the void.
And more.

Blog

This blog summarizes feedback from representatives of consumer advocates, insurers, and state agencies on CMS' proposed annual Notice of Benefits and Payment Parameters, which updates regulations governing the Affordable Care Act’s marketplaces.

Brief

This issue brief identifies several areas in which state departments of insurance may want to coordinate with other agencies or external stakeholders, issue new regulations or guidance, and establish means for minimizing gaps in coverage or access to services once the PHE ends.

Brief

This brief analyzes data from the National Health Interview Survey, the Current Population Survey, and the Health Reform Monitoring Survey to explore trends in coverage status and type between early 2019 and early 2021.

Brief

This brief summarizes key findings from a new study led by Dr. Hannah Neprash which provides direct answers about how clinicians responded to the Medicaid expansion.

Blog

This blog summarizes key takeaways laid out in the new CMS guidance related to timelines and operational strategies states can leverage to mitigate churn when the federal Medicaid continuous coverage requirement ends.

Blog

This blog analyzes comments submitted by state departments of insurance and state-based marketplaces to better understand the impact of The Centers for Medicare & Medicaid Services recently proposed set of rules governing the marketplaces and health insurance standards for next year.

Brief

This brief examines significant challenges and solutions identified by state health officials to mitigate coverage losses.

Commentary

This commentary tells the story of Dominique G., who spent most of her life in hospitals due to sickle cell disease. Medicaid coverage provided her regular hematologist visits, appropriate equipment and medications to make living at home possible.

Dataset

This Databook provides a comprehensive, detailed look at Medicaid enrollment trends from the beginning of the COVID-19 pandemic through November 2021 and enrollment detail by state across four eligibility categories:

Expansion adults
Children (including those enrolled in CHIP)
Non-expansion adults
Aged, blind, and disabled individuals

Blog

This blog provides an overview of the Centers for Medicare & Medicaid Services' RFI regarding the federal standards that govern access to care in Medicaid and the Children’s Health Insurance Program.  

Blog

This blog highlights key themes and topics that governors across the country reflected upon during their state-of-the-state addresses. 

Brief

This brief projects Medicaid enrollment for the population under age 65 and federal and state Medicaid spending for 2022 and 2023, assuming the PHE is extended through the first, second, or third quarters of 2022.

Brief

This brief highlights strategies for states to expand affordable health coverage to immigrant populations in the United States and provides an overview of the status of the public charge rule.

Blog

This Blog explores Oregon's new kindergarten readiness incentive metric in its Medicaid program focused on social-emotional health to help solidify the connection between a child’s health and their success in school and beyond. 

This blog explores the obstacles consumers have faced obtaining free preventive services since the Affordable Care Act (ACA) was enacted in 2010.

Report

This report examines existing data and research to comprehensively describe the scope and prevalence of obesity and available obesity treatments in the US covered by fee-for-service Medicaid, Medicaid managed care, state employee health plans, and state essential health benefits benchmark plans.


Chart, Graphic

This infographic details state-level trends in public coverage, private coverage, and those without health insurance coverage summarizing The National Center for Health Statistics recently released National Health Statistics Report, which presents state-level estimates of health insurance coverage using data from the 2020 National Health Interview Survey.

Blog

This blog summarizes practical steps and recommendations for alternative payment models to help state Medicaid agencies make care more accessible and equitable, and drive better health outcomes. 

Blog

This blog profiles Indiana’s plans to launch Medicaid managed long-term services and supports in 2024, under which a majority of participants are expected to be dually eligible individuals.

Blog

This blog explores value-based, alternative payment models as employer-sponsored health insurance costs have increased by 6.3 percent in the United States since 2010, with additional increases projected.

Commentary

This commentary shares the story of Ashley, who unexpectedly lost the private health insurance she received under her father’s health plan when she moved to New Mexico.

Blog

This blog explores text messaging as a mechanism for outreach for state Medicaid and Children’s Health Insurance Program (CHIP) agencies to directly contact Medicaid and CHIP enrollees and communicate important information.

Brief

This blog summarizes a phased set of priority measures and provides a model enrollment and retention dashboard template that states can use to monitor both the short-term impacts of phasing out public health emergency protections and continuous coverage requirements, as well as longer-term enrollment and retention trends.

Map

This interactive map and chart summarize proposed and approved legislation since 2018, Medicaid waivers, financial estimates, and other initiatives designed to extend coverage during the postpartum period.

Blog

This blog examines the Centers for Medicare and Medicaid Services' newly released State Health Official letter providing guidance on the scope of and enhanced payments for qualifying community-based mobile crisis intervention services for Medicaid enrollees experiencing a mental health or substance use disorder crisis.

Chart

This chart summarizes temporary Medicaid and CHIP flexibilities enacted by the federal government to help states respond to the ongoing COVID-19 pandemic. The chart includes effective dates and expiration dates as dictated by law or agency guidance.  

Report

This toolkit highlights opportunities for states to leverage managed care plans to support unwinding the Medicaid continuous coverage requirement.

Brief

This brief examines provisions of the Notice of Benefit and Payment Parameters for the plan year 2023 related to the state-based marketplaces and state insurance regulators.

Brief

This brief offers considerations for policymakers around the Children’s Health Insurance Program coverage as a method of enabling states to provide prenatal, labor and delivery, and postpartum services to pregnant individuals, regardless of immigration status.

Chart

This informative chart details key components and features of states’ Medicaid doula benefits.

Report

This extensive report provides a communications planning guide and template communications resources designed to support state Medicaid agencies as they prepare for the upcoming end of the continuous coverage requirement.

Blog

This blog examines how state officials are actively planning for the eventual end of the Medicaid continuous coverage requirement that is currently associated with the federal COVID-19 public health emergency and enhanced federal Medicaid matching funds.

Factsheet

This toolkit is a resource for state policymakers interested in strategies to address the problem of prescription drug prices.

This commentary tells the story of Tania, who through Medicaid not only receives mental health care but is also approved to visit specialists who care for her autoimmune disorder, something that would be unaffordable otherwise.

Map

This interactive map and chart summarize proposed and approved legislation since 2018, Medicaid waivers, financial estimates, and other initiatives designed to extend coverage during the postpartum period.

Commentary

This commentary tells the story of Alicia, who was able to access a doula through Medicaid while incarcerated and pregnant with her second child.

Brief

This brief highlights key state actions to increase cancer screening for adults covered by Medicaid and improving health outcomes.

Commentary

This commentary tells the story of Becky, whose Medicaid covers her medical visits and medication, as well as home-based assistance to help manage her multiple sclerosis.

Webinar & Presentations

This webinar provide an overview of strategies for states seeking to ensure that eligible enrollees are able to keep or transition to new affordable health coverage when the Medicaid continuous coverage requirement ends.

Report

This report estimates increases in federal subsidies under two provisions of the Build Back Better Act that would flow to people below the federal poverty limit in the 12 states that have not expanded Medicaid (people in the “Medicaid gap”).

Commentary

This commentary is the story of Theresa, who developed Spastic Quadriplegia Cerebral Palsy and whose Medicaid allows her to work and live independently, and do activities she enjoys such as swimming. 

Webinar & Presentations

This webinar reviewed steps states can take to integrate health equity into their Medicaid managed care programs.

Brief

This brief examines how state Medicaid and public health programs can advance health equity for the communities they serve, especially for people of color, working both within their agency and through cross-agency partnerships.

Commentary

11.2021 /

This commentary tells the story of Adrian, who serves as an assistant director at the Hattiesburg, Miss., office of Youth Villages and oversees the Medicaid-funded Mississippi Youth Programs Around the Clock (MYPAC) effort, which currently has more than 500 people enrolled throughout the state.

Brief

This brief examines the information technology system, policy, and operational strategies states can consider to update key enrollee contact information to ensure eligible enrollees are able to keep or transition to new affordable health coverage at the end of the public health emergency.

Chart

This chart presents efforts by state insurance purchasers using reimbursement rates paid by Medicare as a reference-point to inform their programs’ hospital payments.

Journal Article

This journal article assesses the impact of the Affordable Care Act (ACA) Medicaid expansion on coverage and access to care for a subset of low-income parents who were already eligible for Medicaid when the ACA was passed.

Report

10.2021 / By Urban Institute

This report aims to estimate the Medicaid enrollment trends once the COVID-19 public emergency ends and policies prohibiting disenrolling beneficiaries are nullified.

Webinar & Presentations

This webinar discusses the research on how Medicaid saves lives, reduces costs, and helps eliminate racial and ethnic health disparities.

Report

09.2021 / By Urban Institute

This report examines policies to improve continuous postpartum coverage after the COVID-19 public health emergency ends.

Graphic

This infographic examines how expanded coverage has saved lives, reduced health care costs, narrowed racial disparities, and provided peace of mind to those who would otherwise have been uninsured.

Resource Page

This resource page compiles the latest Robert Wood Johnson funded research on the benefits of closing the Medicaid coverage gap.

Blog

This blog post examines how the American Rescue Plan Act affected the affordability, choice, and coverage stability of health plans on 12 different state-based marketplaces. 

Blog

This blog post outlines the potential coverage gains, state cost savings, and improved health outcomes that would occur if the remaining 12 nonexpansion states extending their Medicaid programs in accordance with the Affordable Care Act. 

Brief

08.2021 / By Urban Institute

This brief examines how enrollment gains in public insurance helped offset declines in employer-sponsored insurance during the COVID-19 pandemic. Unlike previous recessions, the uninsurance rate did not change.

Commentary

This commentary examines how Washington implemented the nation’s first public option for the 2021 plan year and in the first six months of 2021, states made significant progress in advancing public option proposals, with public option legislation advancing in Colorado, Nevada, and Oregon.

Brief

This brief describes Nevada's new public option that is intended to provide consumers with comprehensive, but lower cost health insurance.

Blog

This blog examines the interest in the potential timeline for Medicaid expansion in the remaining states after the passage of the American Rescue Plan Act. 

Report

This report includes a collection of summarized evidence on how Medicaid can improve the health of states' residents and communities.

Report

This report describes the American Rescue Plan Act's (ARPA) Medicaid matching rate provision and also assesses its fiscal impact for each of the states that have not yet expanded Medicaid, while comparing the available new federal dollars to the cost of expansion.

This journal article describes patterns of perinatal uninsurance and health outcomes of women experiencing uninsurance.

Brief

01.2021 / By Urban Institute

This brief present that if the remaining 14 states had expanded eligibility in 2020, 4.4 million fewer people would have been uninsured that year.

Report

This report examines the implications if the outstanding 15 states chose to expand Medicaid eligibility in 2020.

Report

This report describes select policy and strategy levers that Medicaid agencies can employ to improve maternal health outcomes and address outcome disparities in five areas: coverage, enrollment, benefits, models of care, and quality improvement.

Brief

08.2019 / By Urban Institute

Using the American Community Survey, the brief presents that uninsurance increased by 0.2 percentage points between 2016 and 2017 despite a strong economy, meaning 700,000 more uninsured Americans.

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