Medicaid
Medicaid, which currently covers nearly 50 million low-income Americans, funded an estimated $339 billion in services in 2008. As a federal/state partnership with shared authority and financing, states have the option to participate, and all 50 states do so. States must meet the federal minimum requirements, such as covering certain people and offering certain benefits, and also may cover additional “optional” people and services, although significant variations exist among states.
Most Medicaid eligibility currently is determined by income and “categories,” such as children under age 19, pregnant women, adults with dependent children, people with disabilities and the elderly. Childless adults, who typically are not eligible for Medicaid, make up a large percentage of the nation’s uninsured.
The Affordable Care Act (ACA) made significant changes to Medicaid that, for the most part, states are responsible for implementing; a task made more difficult by the economic uncertainty facing states in the last few years.
The ACA expands Medicaid eligibility to all Americans under age 65 whose family income is at or below 133 percent of federal poverty guidelines ($14,483 for an individual and $29,725 for a family of four) by 2014. Childless adults will make up a large percentage of the newly eligible population that is estimated to total about 16 million. In 2014, the ACA will require all states to use “Modified Adjusted Gross Income (MAGI)” for eligibility determination which eliminates resource tests and applies a 5 percent income disregard effectively raising the eligibility level to 138 percent of poverty for most applicants. Another provision affecting Medicaid eligibility is the “maintenance of effort” requirement for all states to maintain Medicaid eligibility levels that were in place on March 23, 2010.
In 2011, nearly every state took steps to contain Medicaid costs. However, states are not just cutting to meet budget demands. Looking toward the 2014 eligibility expansion of Medicaid as dictated by the ACA, state lawmakers are exploring innovative ways to improve the value of the Medicaid program. To improve quality, states are aligning incentives with their desired outcomes and experimenting with new payment models, such as attaching provider payments to patients’ health outcomes and with new delivery systems by creating medical homes and streamlining services for those eligible for both Medicaid and Medicare.
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Medicaid: The 800-Pound Gorilla (State Legislature Magazine October/November 2011)
Although many of the headlines in the debate over federal spending and the deficit focus on Medicare and Social Security, the program of greatest concern to states is Medicaid.
The 46-year-old program, which cost state and federal governments nearly $400 billion in 2009, eats about 16 cents of every dollar in state general funds. It’s been growing two or three times faster than state budgets because of the rising costs of health care and the increasing number of people enrolling because of the stagnant economy.
Meanwhile, state lawmakers are looking down the road three years to when an additional 16 million people will go onto the Medicaid rolls under federal health care reform. And while Congress debates possible modifications in how it funds the program, any changes remain uncertain
Medicaid and the Affordable Care Act (Health Reform Brief 2010)
Medicaid, which currently covers nearly 50 million low-income Americans, funded an estimated $339 billion in services in 2008. Medicaid is a federal/state partnership with shared authority and financing. States have the option to participate, and all 50 states do so. States must meet the federal minimum requirements, such as covering certain people and offering certain benefits, and also may cover additional “optional” people and services, although significant variations exist among states.
Most Medicaid eligibility currently is determined by income and “categories,” such as children under age 19, pregnant women, adults with dependent children, people with disabilities and the elderly. Childless adults, who typically are not eligible for Medicaid, make up a large percentage of the nation’s uninsured. The Affordable Care will make many changes to the Medicaid program, this brief outlines some of these changes.
Federal Health Reform
Under the new federal health reform legislation, Medicaid will be expanded to all Americans with incomes up to 133 percent of federal poverty guidelines ($29,327 a year for a family of four in 2010) effective in 2014. This represents a significant change for state Medicaid programs, which will expand to cover additional people who do not currently qualify. The new law provides states with 100 percent federal financing for all those who are newly eligible for Medicaid for the first two years through 2016. The federal match decreases to 95 percent in 2017; 94 percent in 2018; 93 percent in 2019 and 90 percent for 2020 and beyond. Currently the states share the cost of the Medicaid program with the federal government. The federal government share, called the federal medical assistance percentage or FMAP, is calculated based on a three-year average of state per capita personal income compared to the national average. A state with average per capita personal income receives an FMAP of 55 percent; no state may receive less than 50 percent.
Actions and Proposals to Balance the FY2011 Budget: Health Care
In December 2009, The National Conference of State Legislatures (NCSL) released its State Budget Update: November 2009. The report shows that states closed budget gaps in excess of $145 billion while crafting their FY 2010 budgets only for a new round of shortfalls to open totaling $28.2 billion. In light of these budget gaps, NCSL has compiled this series of tables that document the measures, both proposed and enacted, that states are taking to close their budget gaps. States are taking a variety of approaches to close their budget gaps and the approaches include both cutting budgets and generating new revenues. Actions and Proposals to Balance the FY 2010 Budget: Health Care
Long-Term Care
Long-term care accounts for more than 35 percent of Medicaid budgets. States are reforming their long-term care systems and seeking higher quality, cost efficiency and consumer satisfaction. This webpage includes information about state efforts to reform this area of health care.
Children's Health Insurance Program (CHIP)
The Children's Health Insurance Program (CHIP), formerly the State Childrens's Health Insurance Program created by the Balanced Budget Act of 1997, continues to receive considerable attention as states continue to refine their initial CHIP plans. In Febuary 2009, CHIP was reauthorized under the Obama administration. CHIP plans have been approved in all 50 states, the District of Columbia and five territories. In an effort to provide information on state actions involving CHIP, the CHIP menu page contains several resources about general SCHIP issues as well as more detailed information about implementation topics such as outreach plans and specialized coverage.
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