Filling the need for trusted information on national health issues
Medicaid
- Rebates
Understanding the Medicaid Prescription Drug Rebate Program
The rebate program reduces net federal and state Medicaid spending on prescription drugs. In 2017, Medicaid spent $64 billion on drugs and got $34.9 billion in rebates from manufacturers. Net spending was $29.1 billion. - Managing Costs
Management and Delivery of the Medicaid Pharmacy Benefit
Managing the prescription drug benefit and expenditures is a perennial policy priority for state Medicaid programs, in part because policymakers remain concerned about spending growth. We explore key questions about states’ administration of this benefit. - Prices
Pricing and Payment for Medicaid Prescription Drugs
Medicaid payments for prescription drugs are determined by a complex set of policies, at both the federal and state levels, that draw on price benchmarks. Price benchmarks represent prices paid by different parties at different stages in the drug manufacturing, acquisition, and dispensing processes. We explain how it works.
- Medicaid’s Future
Examining the Coverage Gap in States that Have Not Expanded Medicaid
Nationally, 2.3 million poor uninsured adults are in the “coverage gap” that results from state decisions not to expand Medicaid. Most live in a handful of states .
- PROGRAM INTEGRITY
Medicaid Program Integrity and Current Issues
Medicaid is a large source of federal and state spending. Recent audits and improper payment reports have brought program integrity issues to the forefront. We explain what program integrity is, CMS efforts to address it and current and emerging issues. - Waivers
Why it Matters: Tennessee’s Medicaid Block Grant Waiver Proposal
Tennessee’s proposal to finance its Medicaid program through a “modified block grant” that allows for shared savings could create an incentive for the state to reduce optional eligibility or services for high-cost enrolees so that it can achieve savings. - Medicaid’s Future
Medicaid: What to Watch in 2020
Key issues to watch in 2020 include: Medicaid expansion developments; Section 1115 waiver activity; enrollment and spending trends; benefits, payment and delivery system reforms, and the implications of the 2020 elections.
ACA MEDICAID EXPANSION
State Fact Sheets
How Many People Would Be Eligible for Medicaid if Remaining States Expanded Under the ACA?
As of January 2020, 14 states have not adopted the ACA Medicaid expansion. Across all non-expansion states, 4.4 million uninsured nonelderly adults would become eligible for Medicaid if all opted to expand their programs. Our fact sheets show what’s at stake in each state.
- 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. - The Basics
10 Things to Know about Medicaid
Medicaid covers 1 in 5 low-income Americans, including many with complex and costly needs for care. - 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. - 50-State Survey
A View From the States: Results of a 50-State Medicaid Budget Survey for FY 2019 and FY 2020
We have detailed state-specific information on Medicaid policies and programs, including eligibility, delivery systems, benefits, long-term services and supports, and provider rates and taxes.
Medicaid Work Requirements
Data Analysis
Understanding the Intersection of Medicaid and Work: What Does the Data Say?
Most (63%) of the 23.5 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, are already working full- or part-time.
