This report reviews the key features of the proposed capped funding demonstrations and highlights the considerations for states. On January 30, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a State Medicaid Director Letter (SMDL) inviting states to apply for Section 1115 demonstration projects that would impose caps on federal Medicaid funding for the adult expansion and some other adult populations in exchange for new programmatic flexibility.
This issue brief examines how state Medicaid agencies, families, advocates, providers and other stakeholders can partner to improve access to services for Medicaid-enrolled children with special health care needs.
This report explores what child care challenges parents with Medicaid work requirements may face, and suggests parents may struggle to find care that is affordable, good quality, accessible, and available for nontraditional or unpredictable work schedules.
This webinar reviewed the Department of Homeland Security's final version of its public charge rule, highlighted changes from the proposed rule, and explored the rule’s potential impacts on consumers, states and providers.
This report shares insights from in-depth interviews with 25 adults in immigrant families who reported that they or a family member avoided participating in safety net programs like Medicaid, SNAP, or housing assistance in 2018 because of immigration concerns.
This brief examines the prevalence of precarious work schedules among working adults whose families participate in federal safety net programs, using data from the December 2018 Well-Being and Basic Needs Survey.
This study assesses potential barriers facing Medicaid enrollees in meeting work requirements through employment on a sustained basis, using pooled data from the September 2018 and March 2019 Health Reform Monitoring Survey.
This brief reviews the role that social and economic factors--such as housing, healthy food, and income--play in a “whole person” approach to health care, especially among Medicaid’s low-income enrollees.
This brief reviews the growing body of research on Medicaid's health and economic impacts, including access to care; self-reported health status; preventive health screenings; delaying care because of costs; hospital and ED utilization; and mortality rates.
This brief outlines the basics of the Medicaid program, including financing and eligibility, for new state policymakers in order to lay the groundwork for considering the challenges and opportunities that lie ahead.
This brief highlights priority issues for consideration and potential action, including: the structure of the Medicaid agency; enabling coverage and access; addressing the needs of special populations; and value-based payment policies.
This project encourages state, local, and national level organizations to include health considerations in policy decisions across multiple sectors, such as housing, transportation, and education. Research shows that the conditions in which people live, learn, work, and play influence their health, so the project also works to create cross-sector partnerships that include the expertise of health care and public health systems.
The Department of Homeland Security’s (DHS) proposed rule, Inadmissibility on Public Charge Grounds, proposes significant changes to how it will determine whether an immigrant is likely to become a “public charge” including, for the first time, the use of Medicaid benefits as a key factor in that analysis.This resource answers popular questions about the rule.
This resource highlights articles published since January 2018 that report on the impact of Medicaid expansion in 33 states and DC, organized by health access and outcomes, economic impacts, and coverage impacts.
This report explores changes in coverage type between 2013 and 2016 overall and for key demographic and income subgroups. Between 2013 and 2016, the share of Americans ages 64 and younger without health insurance fell from 17 percent to 10 percent.
This brief examines changes in health insurance coverage and health care access and affordability for parents and their children between 2013 and 2018 using data from the Health Reform Monitoring Survey.
This report provides detailed estimates of changes in health insurance coverage types between 2013 and 2016 by demographic, socioeconomic, and geographic characteristics. In addition, state fact sheets detail coverage changes by income group in all 50 states and DC.
CMS approved state work/community engagement (CE) waivers in Arkansas, Indiana, Kentucky, and New Hampshire; and additional states have submitted or are poised to submit similar waivers. This series of charts outlines the legal, policy, financial and operational tasks and issues that states will face in adding a work/CE condition to their Medicaid program.
This report investigates the work patterns of Medicaid beneficiaries in Kentucky who are are potentially subject to Medicaid work requirements. It finds that the structure of Kentucky’s Medicaid waiver does not seem to align with the reality of some working enrollees’ lives, and that working enrollees losing coverage may not have access to an employer plan.
This webinar reviews the Stewart v. Azar decision and potential implications for states with approved, pending or planned Medicaid waivers that include work/community engagement requirements. The court’s findings may shape what analysis will be necessary to demonstrate that future waivers advance the Medicaid statute's objectives.
Webinar discusses the status of state efforts to secure waivers to use federal Medicaid funding to provide care in Institutions for Mental Disease (IMD), including the requirements states must meet to secure an IMD waiver; the status of requests and approvals; and issues and opportunities arising as states pursue and increasingly implement the IMD waiver.
States continue to identify and pursue strategies to further reduce the number of uninsured to make coverage more affordable for consumers and to improve access to care. This issue brief presents two possible models for a Medicaid buy-in program for states, and details the design considerations and authorities needed to implement each model.
This map tracks state Medicaid expansion decisions and approaches states are taking for expanding eligibility to 138 percent of the Federal Poverty Level. It also includes information on state legislative activity around Medicaid expansion, governors’ stances on the issue, and fiscal and demographic analyses from the state or other institutions. For states that are expanding Medicaid, but using an alternative to traditional expansion, the map also contains brief descriptions of these demonstration waivers.
In January 2018, the Centers for Medicare & Medicaid Services issued a new policy allowing states to implement work and community engagement requirements for certain Medicaid enrollees. States are permitted to seek federal approval to require non-elderly, non-pregnant, and non-disabled adults to participate in these types of activities to qualify for Medicaid or certain aspects of Medicaid coverage. This chart summarizes states’ pending and approved Section 1115 waivers, waiver renewals, and waiver amendments to implement work and community engagement requirements.
In this brief, we provide an overview of the lessons learned from work requirements for Temporary Assistance for Needy Families (TANF, or cash assistance) and Supplemental Nutrition Assistance Program (SNAP, formerly Food Stamps) and discuss the implications of introducing or expanding work requirements.
The Profile of Virginia’s Uninsured provides a detailed picture of the Commonwealth’s uninsured using the 2016 American Community Survey. In 2016, 10.3 percent of Virginians under age 65 were uninsured. Most of these uninsured nonelderly Virginians had family incomes at or below 200 percent of the Federal Poverty Level (FPL), and more than three-quarters were part of working families.
This article analyzes the impact of the Affordable Care Act on health insurance coverage for verterans in states that chose to expand Medicaid and in non-expansion states using data from the 2013 and 2014 American Community Survey. The analysis found a substantial 24 percent relative decline in the rate of uninsurance for U.S. veterans between 2013 and 2014. Coverage gains in rural areas were due to gains in Medicaid and individual market coverage. The increase in the insured rate was three times larger in Medicaid expansion states versus non-expansion states.
In January 2018, CMS approved Kentucky’s Section 1115 Medicaid demonstration waiver, which allows the state to require some beneficiaries to participate in “community engagement” activities for at least 80 hours a month to retain their Medicaid coverage. This brief revises an earlier analysis on who could be affected by Kentucky’s Medicaid work requirements based on new information posted on Kentucky’s website.
This issue brief summarizes key features of the February 9, 2018 10-year CHIP extension. CHIP covers nearly 9 million children and is a key contributor to record-low levels of uninsurance among children.
The nation’s opioid epidemic claimed more than 42,000 lives in 2016, and more than 2 million people in the United States have an opioid use disorder (OUD). Yet, only 1 in 5 people suffering from an OUD receive treatment. In this issue brief, data from three states—New Hampshire, Ohio and West Virginia—highlight Medicaid’s role as the linchpin in states’ efforts to combat the opioid epidemic.
On January 11, CMS released a State Medicaid Director letter providing guidance for states seeking 1115 waivers that condition Medicaid eligibility on work and community engagement, quickly followed by approval of Kentucky’s 1115 waivers that include these requirements. In this webinar, State Health and Value Strategies and Manatt Health review the new guidance, including key design parameters, budget neutrality requirements, and monitoring and evaluation criteria.
On January 11, 2018, CMS released guidance for states seeking 1115 waivers that condition Medicaid eligibility on work and community engagement, quickly followed by approval of Kentucky’s 1115 waivers that include these requirements. Both the new guidance and recent waiver approval represent a significant departure from past Administrations’ positions. This webinar reviews the new guidance and discusses state legal, policy, and operational considerations.
Uncertainty about the future of health insurance options and concern about the ability of Affordable Care Act (ACA) marketplaces to offer adequate competition and choice have spurred states to look for new coverage approaches. Innovative strategies states are proposing include allowing consumers to buy into state Medicaid programs and developing state-specific coverage options within the ACA’s framework.
This webinar features the Urban Institute's Dr. Fred Blavin, whose SHARE-funded research asks how medical spending burdens for near-poor families in non-expansion states would change if the states were to expand Medicaid.
The Administration signaled a willingness to give states more flexibility to address health and prevention in new and innovative ways under Section 1115 of the Social Security Act, allowing the Department of Health and Human Services to approve experimental and innovative projects that promote the goals of Medicaid. This comes at a pivotal time when many states are developing new ways to improve health care, reduce costs, and address health-related social needs such as housing.
State policy makers are increasingly focused on social determinants of health (SDOH) because of the important influence of these determinants on health care outcomes and Medicaid spending. Social determinants include a broad array of social and environmental risk factors such as poverty, housing stability, early childhood education, access to primary care, access to healthy food, incarceration and discrimination. This report digs into opportunities that states have to account for SDOH in Medicaid programs.
CMS has signaled a willingness to evaluate new types of Medicaid proposals from states, such as Medicaid waiver applications that include programs to connect individuals to employment or incorporate features of private market coverage. In response to CMS’ letter, some states have developed proposals that include these types of requirements for certain individuals covered by the Affordable Care Act’s Medicaid expansion—and a few states are seeking similar changes for their non-Medicaid expansion populations.
Under the authority of Section 1115 demonstrations, some states have implemented DSRIP programs to improve care, improve health, and lower costs. DSRIP programs restructure Medicaid funding into a pay-for-performance arrangement in which providers earn incentive payments outside of capitation rates for meeting certain metrics or milestones based on state-specific needs and goals, which are used to measure success.
This report explores Louisiana’s permanent supportive housing program. The program, administered jointly by the state’s Medicaid agency and housing authority, is a cross-agency partnership that braids funding to serve vulnerable cross-disability populations, address homelessness, reduce institutionalizations, and save money for the state.
While the focus of debate regarding repeal of the Affordable Care Act (ACA) has been on Marketplaces and the Medicaid expansion, myriad other provisions of the ACA are at risk of repeal—including those that streamline Medicaid eligibility and enrollment systems and implement a national, simplified standard for income eligibility. As of January 2016, 37 states are able to complete an eligibility determination in real time, defined as less than 24 hours, and among these, 11 states report that at least half of their applicants receive an eligibility determination in real time. The future of the ACA’s streamlined eligibility and enrollment-related provisions and the system improvements states have invested in to implement them are the subject of this issue brief.
In order to assist states in the facilitation of Medicaid enrollment and renewal for eligible SNAP participants, this webinar presents some of the necessary considerations for leveraging these data for enrollment purposes.
This report stems from technical assistance provided to California’s Department of Health Care Services (DHCS). The technical expert facilitated webinars and meetings with DHCS staff and medical directors of contracted MCOs, in order to share information about housing resources and emerging practices for improving care and achieving savings by linking more Medicaid beneficiaries with permanent supportive housing.