State Medicaid Reforms In the past five years, Medicaid enrollment grew when more people became eligible for the program because of the economic downturn and the reduction in employer sponsored insurance.  At the same time, health care costs were rising--in fact Medicaid spending across the country grew faster than all other state programs.  These and other factors forced states to address Medicaid reform.  This menu page provides updates about recent Medicaid waivers and some Medicaid state plan amendments.

Employers Disclosure Increasing concerns surrounding the Medicaid budget have caused policymakers to take on the role of "sleuth."  State lawmakers are interested in determining if Medicaid beneficiaries have the option of employer-sponsored health insurance.  If Medicaid beneficiaries do not have this option, policymakers want to know which employers are not offering health insurance.  This menu pages contains information about state actions that require Medicaid departments to collect and report data about the beneficiaries of public assistance programs.  

HIFA The U.S. Department of Health and Human Services invited states to participate in the Health Insurance Flexibility and Accountability demonstration initiative beginning August 4, 2001. The purpose of the initiative is to expand health insurance coverage to the uninsured within currently available Medicaid and State Children's Health Insurance Program (SCHIP) resources.

Federal Medicaid Issues

2005 Deficit Reduction Act (DRA): How It Affects Medicaid The federal Medicaid menu page contains a summary of and links to information about the Deficit Reduction Act Of 2005 and its health provisions, including information on the following topics:  Medicaid prescription drug reforms; long-term care reforms and transfer of assets;  long-term care reforms with home and community-based care; eliminating fraud, waste and abuse; flexibility in cost-sharing and benefits; state financing; family opportunity act provisions; State Children's Health Insurance; hurricane Katrina assistance; state high-risk pool funding; low income home energy assistance program; and Medicare.

CMS Guidance Regarding Citizenship Documentation Requirements for Medicaid Applicants The DRA imposed new requirements on states in verifying citizenship or nationality of Medicaid recipients. Effective July 1, 2006,  this prohibits states from receiving federal reimbursement for medical assistance provided under the Medicaid program to any individual who has not provided satisfactory documentary evidence of his or her citizenship or nationality. The documentation requirements do not apply to an immigrant who is (1) eligible for Medicaid and is entitled to or enrolled for Medicare benefits, (2) eligible for Medicaid on the basis of receiving Supplemental Security Income benefits, or (3) eligible for Medicaid as specified by the secretary under which satisfactory documentary evidence of citizenship or nationality had been previously presented. 

Prescription Drugs
Relentless increases in public spending for medications (averaging almost 15% annually since 2000) led states to a widespread focus on policy changes, including varied cost containment plans in all 50 states.  The federal Medicare benefit, launched in January 2006, mandated a major shift of elders and residents with disabilities away from Medicaid and into Medicare.  But states now pay for both Medicaid and Medicare drug coverage.  They remain active players in balancing access and cost effectiveness. NCSL has more than a dozen reports and presentation detailing current trends.

Medicaid Prescription Drug Laws & Strategies States are considering or have enacted a variety of changes in their Medicaid programs to respond to the challenges arising from increased demand for and higher costs of prescription drugs. Recent state legislation related to Medicaid prescription drugs generally is designed around new or expanded applications of management tools already available to states through federal law. Among the strategies receiving legislative attention are use of: preferred drug lists (PDL) or formularies, generic substitution, cost-sharing or co-payments, multi-state purchasing, pharmacy benefit managers (PBMs),  prior authorization,  drug utilization review (DUR), dispensing fees, ingredient fees, and supplemental rebates from manufacturers. This prescription drug menu page contains information about these strategies.

Pharmacy Plus - Medicaid Waivers Two new types of state-initiated pharmaceutical programs that "partner" with federal Medicaid attracted national attention between 2001 and 2005. This report provides details on:
1) "Pharmacy Plus" subsidy programs that combine state and federal funds, and
2) "Discount-only" pharmaceutical benefits, exemplified by the "Healthy Maine" program.

Pharmaceuticals: Overview and NCSL Resources

State Pharmaceutical Assistance Programs in 2006-07: Helping to Make Medicare Part D Easier and More Affordable