Medicaid
Medicaid HCBS
Focus Groups: Direct Care Workers and Unpaid Caregivers Describe Low-Wage Work Marked by Physical and Mental Stress
In recent focus groups, paid direct care workers and unpaid caregivers describe daily work defined by low pay, physical demands and mental stress that has been made worse by the pandemic.
KFF conducted the four focus groups to help provide context for the ongoing debate in Congress about increasing federal funding for Medicaid home and community-based services (HCBS). Medicaid is the nation’s primary payer for such services. New funding could help raise wages, provide training opportunities and offer supports to family caregivers.
KFF conducted the four focus groups to help provide context for the ongoing debate in Congress about increasing federal funding for Medicaid home and community-based services (HCBS). Medicaid is the nation’s primary payer for such services. New funding could help raise wages, provide training opportunities and offer supports to family caregivers.
- u.S. Territories
Implications of the Medicaid Fiscal Cliff for the U.S. Territories
The U.S territories – American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Puerto Rico, and the U.S. Virgin Islands (USVI) – have faced an array of longstanding fiscal and health challenges that were exacerbated by recent natural disasters and most recently by the COVID-19 pandemic. While temporary federal funds have helped, they are set to expire at the end of September 2021 unless Congress extends the assistance. We examine the effects of the pandemic and the implications of the looming Medicaid funding cliff. - Premiums & Cost Sharing
Understanding the Impact of Medicaid Premiums & Cost-Sharing: Updated Evidence from the Literature and Section 1115 Waivers
Research on premiums and cost-sharing for low-income populations indicates that these policies lead to reduced coverage, worse access to care, and increased financial burden. We review the research. We also summarize approved Section 1115 waivers allowing eight states to charge premiums to enrollees below 150% FPL and analyze available data on the impact of these premiums from five states. - Coverage Gap
Taking A Closer Look At Characteristics of People in the Coverage Gap
Twelve states have not adopted the ACA Medicaid expansion to adults with incomes through 138% of poverty, leaving 2.2 million people in the coverage gap. They would be eligible for Medicaid if their state adopted the expansion but currently do not qualify for Medicaid and have incomes below poverty, making them ineligible for subsidies in the ACA Marketplace. As policy makers debate whether and how to extend coverage to people in the gap, understanding the characteristics of this group can help inform policy decisions. - Medicaid HCBS
Children with Special Health Care Needs: Coverage, Affordability, and HCBS Access
Our analysis examines key characteristics of children with special health care needs, the affordability and adequacy of their health coverage, and the implications for such children of potential new federal Medicaid money to assist families in caring for them.
Medicaid is a significant source of coverage for such children, including HCBS. During the pandemic, children have experienced health care disruptions, mental health challenges, and economic hardships, and these issues may have been intensified for those with special health care needs. - Housing
Housing Affordability, Adequacy, and Access to the Internet in Homes of Medicaid Enrollees
Medicaid covers a considerable number of people living in homes that are unaffordable, inadequate or have limited access to the internet, all of which can affect health. We look at the limited role Medicaid can play in addressing these challenges. State Medicaid programs can add certain housing supports for high-need enrollees as part of home and community-based services programs, through 1115 waivers, and a limited set of other options. Medicaid can also connect enrollees to social services.
LTC & COVID-19
Long-TERM CARE and COVID
The Decline in COVID-19 Deaths Among Nursing Home Residents and Staff Reversed Course Amid the Surging Delta Variant
The months-long decline in COVID-19 deaths among nursing home residents and staff reversed course this summer as the Delta variant dominated, with mortality increasing five-fold from 350 deaths in July to nearly 1,800 in August. Our analysis also finds increases in nursing home COVID-19 cases and deaths were steeper than those in the broader community between July and August.
Coronavirus
Emergency Authorities
How Have States Used Medicaid Emergency Authorities During COVID-19 and What Can We Learn?
The COVID-19 pandemic prompted wide adoption by states of Medicaid emergency authorities to expand Medicaid capacity and services, targeting providers and enrollees with help to mitigate the effects of the public health emergency. We review state actions and potential lessons learned. Some states had begun to unwind these Medicaid flexibilities, but the Delta variant and low vaccination rates may present renewed challenges.
ACA MEDICAID EXPANSION
Literature Review
Building on the Evidence Base: Studies on the Effects of Medicaid Expansion, February 2020 to March 2021
Our latest literature review provides context for these expansion debates by summarizing evidence from nearly 200 studies about the effects of Medicaid expansion that were published between February 2020 and March 2021.
The report highlights study findings across multiple key themes of interest, including mortality, cancer, chronic disease, and disabilities, sexual and reproductive health, behavioral health, economic impacts on states and providers, disparities and social determinants of health.
Prescription Drugs
Analysis
Costs and Savings under Federal Policy Approaches to Address Medicaid Prescription Drug Spending
Several recent policy proposals address the cost of prescription drugs to both consumers and payers Congress has already started hearings on other legislation to target drug prices and could include such proposals in forthcoming budget reconciliation bills. This brief analyzes leading federal approaches to address Medicaid prescription drug spending, discusses (where available) a range of cost estimates for each policy, and assesses what drives those estimates.
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Medicaid Budget Survey
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Medicaid Spending and Enrollment Trends Amid the COVID-19 Pandemic – Updated for FY 2021 & Looking Ahead to FY 2022
The public health and economic effects of the pandemic continue to put pressure on Medicaid spending and enrollment. State Medicaid agencies expect overall FY 2021 enrollment to exceed original projections (30 of 37 responding states). Two-thirds of states with updated projections for FY 2021 expect total Medicaid spending to exceed original projections. State projections for FY 2022 were mixed if spending growth would be higher or lower relative to FY 2021
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State Medicaid Programs Respond to Meet COVID-19 Challenges: Results from a 50-State Medicaid Budget Survey
Our annual in-depth, state-specific examination of policy changes and initiatives in Medicaid programs find that this year many involve responses to the COVID-19 pandemic. We present the latest on eligibility and enrollment, provider rates, delivery systems, long-term services and supports, pharmacy actions, benefits, cost-sharing, telehealth and more.
Medicaid Work Requirements
Work Among Medicaid Adults: Implications of Economic Downturn and Work Requirements
Most (63%) of the 22 million adults with Medicaid coverage in the U.S. who are not eligible for both Medicare and Medicaid, and who do not receive federal disability payments, were already working full- or part-time prior to the pandemic, according to the most recent data available. Among those not working, caregiving responsibilities were a primary reason, as well as illness, disability or school attendance. The industries in which many Medicaid enrollees work, including construction, restaurants, and food services, have been among those hit hardest by the pandemic.
- Tracker
Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State
Bookmark our Medicaid waiver tracker page for the latest information on pending and approved Section 1115 Medicaid waivers. - What to Watch
The Effects of Medicaid Expansion under the ACA: Studies from January 2014 to January 2020
This issue brief summarizes findings from 404 studies of the impact of state Medicaid expansions under the ACA published beginning in January 2014 (when the coverage provisions of the ACA went into effect) and January 2020. It groups outcomes into three broad categories: coverage, access, and economic measures. - Data Collection
Medicaid Managed Care Market Tracker
Sixty-nine percent of Medicaid beneficiaries nationally get care through managed care organizations. Get state-level, MCO-level and parent firm-level data. - FInancing
Medicaid Financing: The Basics
Medicaid represents $1 out of every $6 spent on health care in the U.S. and is the major source of financing for states to provide coverage of health and long-term care for low-income residents. We explain how financing for the program works.
- Survey
Medicaid and CHIP Eligibility and Enrollment Policies as of January 2021: Findings from a 50-State Survey
Our 19th annual survey of Medicaid and CHIP program officials provides data on eligibility levels in every state. It also examines key aspects of state enrollment and renewal procedures in place during the COVID-19 public health emergency.
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