Transcript PPT file - The Henry J. Kaiser Family Foundation

Web Briefing for Journalists:
Key Issues Around Medicaid Expansion Efforts
in the States
Wednesday, February 18, 2015
Presented by the Kaiser Family Foundation
Rakesh Singh - Moderator
Vice President for
Communications
Kaiser Family Foundation
Laura Snyder – First Presenter
Senior Policy Analyst
Kaiser Family Foundation
Robin Rudowitz – Second Presenter
Associate Director, Kaiser Commission
on Medicaid and the Uninsured
Kaiser Family Foundation
Medicaid is being transformed under the ACA.
Before
ACA Vision
Health Insurance Coverage
for Certain Individuals
Coverage for All Adults and
Children Up to at Least
138% FPL at State Option
Shared Financing
States and Federal Govt.
Additional
Federal Financing
for New Coverage
Antiquated
Enrollment Process
Modernized, Simplified
Enrollment Process
Support for
Health Care System
Delivery System Reforms
The ACA Medicaid expansion fills current gaps in coverage.
NOTE: The June 2012 Supreme Court decision in National Federation of Independent Business v. Sebelius maintained the
Medicaid expansion, but limited the Secretary's authority to enforce it, effectively making the expansion optional for states. 138%
FPL = $16,424 for an individual and $27,724 for a family of three in 2015.
All states must modernize Medicaid application and
enrollment processes.
PAST
Apply in person
ACA Vision
Multiple options
to apply
No Wrong Door
to Coverage
Provide paper
documentation
Electronic
verification
$
Data
Hub
Wait for eligibility
determination
#
Real-time
determination
Dear __,
You are
eligible for…
Medicaid
CHIP
Marketplace
Over half of states are currently implementing the
Medicaid expansion.
VT
WA
MT
ME
ND
NH*
MN
OR
WI*
SD
ID
WY
NV
PA*
IL
UT
CO
CA
MI*
IA*
NE
IN*
OH
WV
KS
MO
KY
OK
NM
TX
AK
AL
DC
SC
AR*
MS
VA
CT RI
NJ
DE
MD
NC
TN
AZ
MA
NY
GA
LA
FL
Adopted (29 States including DC)
Adoption under discussion (7 States)
Not Adopting At This Time (15 States)
HI
NOTES: Under discussion indicates executive activity supporting adoption of the Medicaid expansion. *AR, IA, IN, MI, and PA have
approved Section 1115 waivers. Coverage under the PA waiver went into effect on 1/1/15, but the newly-elected governor has
stated he will transition coverage to a state plan amendment. Coverage under the IN waiver is set to begin 2/1/15. NH has
submitted a waiver to continue their expansion via premium assistance. WI covers adults up to 100% FPL in Medicaid, but did not
adopt the ACA expansion.
SOURCE: “Status of State Action on the Medicaid Expansion Decision,” KFF State Health Facts.
http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/
Expansion states expect to see higher enrollment growth in
FY 2015 with spending growth largely supported by federal
funds.
NOTE: Data show the year over year change in spending between SFY 2014 and SFY 2015. Expansion states include 28 states;
Indiana, which adopted the Medicaid expansion after this survey, is included in the non-expansion state group.
SOURCE: KCMU survey of Medicaid officials in 50 states and DC conducted by Health Management Associates, October 2014.
The Medicaid expansion has implications beyond the
Medicaid program.
Reduction in the Number
of Uninsured
Increased Provider
Revenue
+
Increased State Savings
Federal + State
Funds
↓ Uncompensated Care Costs
↓ State-funded health
programs (e.g. Mental health)
Increased State
Economic Activity
↑ Jobs and Revenues
The process for a state to adopt the Medicaid expansion
requires partners at the state and federal level.
In order to adopt the Medicaid Expansion,
States must make changes to:
State
Lawmakers
State Law or
Regulation
State
Medicaid
Agency
Authorization
and
Appropriations
Source: Kaiser Commission on Medicaid and the Uninsured.
Medicaid
State Plan
State Plan Amendment
(SPA) or
Section 1115 Waiver
Federal
Medicaid
Agency
(CMS)
Most states are implementing the Medicaid expansion as set forth
by law, but a limited number have approved or are seeking waivers.
Approved Waivers
Waiver Provision
Proposed Waivers
AR
IA
IN
MI
Premium
Assistance
X
X
X
Premiums /
Monthly
Contributions
X
X
X
X
Healthy Behavior
Incentives
X
X
Benefits (NEMT)
X
X
PA*
NH
UT
TN
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Work Referral
X
Reasonable
Promptness
X
Retroactive
Eligibility
X
Co-payments
X
Note: *Governor Wolf in PA said he will transition from a waiver to a SPA
X
X
X
Newly approved
provisions
X
What CMS approves or denies sets the guideposts for
other states.
• Indiana waiver included approval for additional provisions:
– 6-month lock-out period for not paying premiums (between 100-138% FPL)
– Coverage to begin after 60 days or after payment of premiums
– Authority to implement higher co-payments ($8 for first visit and $25 for subsequent
visits in the same year) for non-emergency ER use through § 1916(f)
• CMS has issued guidance to prohibit waivers to impose enrollment caps or
implement partial expansion and access enhanced match
• CMS has denied proposals to:
– Impose premiums as a condition of eligibility for beneficiaries below poverty
– Waive certain required benefits such as EPSDT and free choice of family planning
provider
– Impose work requirements as a condition of eligibility
In states that have not expanded Medicaid under the ACA,
there are large gaps in coverage available for adults.
46% FPL
$9,100 for parents
in a family of three
as of February 2015
NOTE: Based on 2014 poverty thresholds.
Nationwide, there are 3.7 Million low-income adults estimated to
fall into the coverage gap.
Distribution By State:
Distribution By Geographic Region:
Total = 3.7 Million in the Coverage Gap
Notes: Excludes legal immigrants who have been in the country for five years or less and immigrants who are undocumented.
The poverty level for a family of three in 2015 is $20,090. Totals may not sum to 100% due to rounding.
Source: “Number of Poor Uninsured Nonelderly Adults in the ACA Coverage Gap,” KFF State Health Facts.
http://kff.org/health-reform/state-indicator/number-of-poor-uninsured-nonelderly-adults-in-the-aca-coverage-gap/#.
Looking Ahead
• Will more states adopt the Medicaid expansion?
– Will more states submit waivers to implement the expansion?
• What will the effects of the Medicaid expansion be on the
uninsured, state budgets overall, state economies and providers?
• What will we learn from current expansion waivers?
– Effects on beneficiaries in terms of access to care and outcomes
– Ability of states to administer and the federal government to track complex waiver
programs
• How will Medicaid costs and coverage growth compare in
expansion and non-expansion states going forward?
• How will individuals in the coverage gap fare?
Q&A Discussion
Contact Information
Chris Lee, Senior Communications Officer
Kaiser Family Foundation | Washington, D.C.
Email: [email protected]
Relevant Resources from KFF
• NEW: An Overview of Actions Taken by State Lawmakers
Regarding the Medicaid Expansion
• NEW: Are Uninsured Adults Who Could Gain Medicaid
Coverage Working?
• UPDATED: The ACA and Medicaid Expansion Waivers
• Current Status of State Medicaid Expansion Decisions
kff.org/medicaid
Thank you!
Until next time, keep up with the Kaiser Family Foundation online:
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@KaiserFamFound
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