The NCSL Blog


By Samantha Scotti

States passed more than 800 laws related to health system innovations in 2016, including at least 120 laws related to Medicaid reforms.

Doctor talking to patientThrough the Health Innovations State Law Database and other resources, NCSL’s Health Program staff helps legislators and their staff learn about health system reforms and Medicaid innovations that promote a more efficient and effective health care system. Medicaid topics covered in the database include:

  • General Medicaid innovations.
  • Medicaid payment reform.
  • Medicaid expansion and waiver legislation.



Enacted Medicaid Innovations Legislation

Medicaid innovations graph

In 2013 states spent, all together, $199.2 billion on Medicaid, which accounted for 18.9 percent of spending from state general funds. Reforming their Medicaid programs to improve access, control costs and increase quality remains an ongoing effort in states. Some examples from the more than 120 Medicaid laws highlighted in the database from 2016 are:

General Medicaid innovations: General Medicaid transformation initiatives, passed and signed in 37 states since January 2016, vary in intent. For example: Wisconsin Assembly Bill 408 requires the Department of Health Services to create pilot projects to test alternative, coordinated care delivery and payment models to reduce the cost of Medicaid recipients with significant or chronic illness. Alabama Senate Bill 268 addresses continuity of health care coverage for prisoners when leaving the corrections system by requiring that Medicaid benefits be suspended rather than terminated during incarceration. West Virginia House Bill 4347 requires substance abuse treatment providers who accept Medicaid eligible individuals to give pregnant women priority in accessing services.

Medicaid expansion and waiver legislation: Several states also considered expanding Medicaid benefits or adding services to their waivers this past session. Utah House Bill 437 expanded eligibility for Medicaid services to certain people who are chronically homeless, involved with criminal justice or in need of mental health or substance abuse treatment services. Indiana Senate Bill 165 codifies the Healthy Indiana Plan 2.0 into law. The legislation modifies the state’s current plan, which was seen as an alternative Medicaid expansion model, incorporating cost sharing measures such as monthly contributions to a Personal Wellness and Responsibility health savings account. It has become a roadmap for several other states.

Medicaid payment reforms: Alaska Senate Bill 74, a comprehensive Medicaid reform act, includes provisions relating to payment reform, telehealth and Medicaid fraud and abuse. It encourages the Department of Health and Social Services to look at alternative payment mechanisms for providers, with models such as bundled payments for specific episodes of care or for case managers for specific diagnoses. Illinois House Resolution 232 creates the Medicaid Managed Care Oversight Task Force to monitor how the state approaches and delivers managed care services, particularly for people with disabilities and the elderly.

Similar pieces of legislation and related information, including the full text of the bills, can be found on the Health Innovations State Law Database Website.

The NCSL Database is updated weekly during state legislative sessions. NCSL staff are responsible for topic selection and summary descriptions, using data powered by StateNet. It is funded primarily by a grant from The Commonwealth Fund with additional research staff supported by the Health Resources and Services Administration. 

Samantha Scotti is a research analyst in NCSL's Health Program.

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This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.