- u.S. TerritoriesThe 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 WaiversResearch 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 GapTwelve 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 HCBSPresident Biden and some in Congress want up to $400 billion in new funding to expand access to Medicaid home and community-based services and boost the direct care workforce. In our updated analysis, we discuss more about how HCBS money could be used. HCBS assist with self-care, such as eating and bathing, and household activities, such as preparing meals, for people who need help with these tasks due to health or functional needs. An increase of $400 billion could boost spending for Medicaid HCBS by at least 33 percent annually.
- HousingMedicaid 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.
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
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.
Bookmark our Medicaid waiver tracker page for the latest information on pending and approved Section 1115 Medicaid waivers.
- What to WatchThis 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 Sixty-nine percent of Medicaid beneficiaries nationally get care through managed care organizations. Get state-level, MCO-level and parent firm-level data.
- FInancingMedicaid 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.
Medicaid and CHIP Eligibility and Enrollment Policies as of January 2021: Findings from a 50-State SurveyOur 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.