Medicaid

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.

The health and economic effects of the pandemic have significant implications for Medicaid.  Medicaid, which provides coverage of health and long-term care for low-income residents, is administered by states within broad federal rules and jointly funded by states and the federal government. Medicaid is a counter-cyclical program, meaning that more people become eligible and enroll during economic downturns; at the same time, states may face declines in revenues that make it difficult to fund the state share of funding for the program. As in past economic downturns, the federal government has provided additional financial assistance to states during the current pandemic to help them maintain their Medicaid programs at a time of growing need.  This brief presents the most current data for key indicators to help understand how various economic factors that could affect Medicaid enrollment and spending are changing in light of the pandemic.

COVID-19 deaths and cases among residents and staff of long-term care facilities have fallen dramatically since vaccinations began in December, with deaths declining by nearly 89% and cases declining by nearly 92% as of April 2021. By mid-April, about a third (34%) of all COVID-19 deaths were in long-term care facilities, down from a peak of nearly half (49%) in June 2020 and 42% around the time that long-term care residents and staff began receiving vaccines in late December. However, eight states experienced a rise in COVID-19 cases in long-term facilities between March and April 2021.

The $400 billion for Medicaid home and community-based services in the Biden admininstration’s American Jobs Plan would be in addition to current federal spending on HCBS in 2021 of $114 billion baseline and the recent $11.4 billion bump from the American Rescue Plan Act. 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.

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.

Policies designed to generate federal or state savings are likely to have implications for and invoke behavioral responses from other entities including drug manufacturers, pharmacies, managed care organizations (MCOs) and pharmacy benefit managers (PBMs). This report examines how leading federal and state policy proposals that increase Medicaid drug rebates, increase price transparency, and target drug prices could affect these entities, which could influence debate over these proposals and what the effects would be.