Medicaid Expansion Waivers: What Will We Learn?
Introduction
The 32 states include DC. Kaiser Family Foundation, Status of State Action on the Medicaid Expansion Decision (Jan. 12, 2016), https://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/.
In January 2016, New Hampshire transitioned from a state plan amendment to a waiver, and expansion coverage in Montana became effective. Pennsylvania initially obtained a waiver to implement the expansion but subsequently transitioned to a traditional expansion under a state plan amendment. Detailed summaries of the expansion waivers are available at https://www.kff.org/tag/waivers/.
Kaiser Family Foundation, A Guide to the Supreme Court’s Decision on the ACA’s Medicaid Expansion (Aug. 2012), https://www.kff.org/health-reform/issue-brief/a-guide-to-the-supreme-courts-decision/.
Robin Rudowitz and MaryBeth Musumeci, The ACA and Medicaid Expansion Waivers (Washington, D.C.: Kaiser Family Foundation, November 2015), https://www.kff.org/medicaid/issue-brief/the-aca-and-medicaid-expansion-waivers/.
Issue Brief
The federal waiver evaluation contract was awarded to Mathematica Policy Research and its partners, Truven Health Analytics and the Center for Health Care Strategies.
Mathematica released the waiver evaluation design plan in May, 2015.
Wisconsin is included in the federal evaluation but this brief does not include an analysis of the state evaluation plan because the state has not adopted the Medicaid expansion.
In addition, CMS contracted with the Urban Institute to conduct a federal evaluation of HIP 2.0 in addition to the state evaluation that will be conducted by the Lewin Group. Governor Pence wrote a letter to Secretary Burwell expressing concerns about need for the second evaluation and the objectivity of the selected contractors. No information has been released about the design plan for the federal evaluation of HIP 2.0. The Governor’s letter from December 3, 2015 can be found here: http://media.mcguirewoods.com/mwc/Mike-Pence-Letter-Dec-3-2015.pdf
Originally, Iowa’s waiver required expansion adults from 100-138% FPL to enroll in a Marketplace QHP with Medicaid premium assistance. As of October, 2014, Marketplace enrollment was voluntary for this group after one of the two QHPs serving Medicaid beneficiaries left the Marketplace. Subsequently, the other QHP decided that it would no longer accept new Medicaid enrollees, and Iowa submitted a waiver amendment request to CMS seeking to require all expansion adults to enroll in capitated Medicaid MCOs as of January, 2016.
Both states have waiver authority to use state-developed tests to measure the cost-effectiveness of their premium assistance programs that differ from those otherwise permissible under federal law.
Many of these challenges were highlighted in the Federal Evaluation Design Plan. https://www.medicaid.gov/medicaid-chip-program-information/by-topics/waivers/1115/downloads/evaluation-design.pdf
The Oregon Health Insurance Experiment, The National Bureau of Economic Research, http://www.nber.org/oregon/
Kronick and Bindman, NEJM 368;18, May 2, 2013
Harold Pollack, Oregon Medicaid experiment “is a Rorschach test of people’s views of the ACA” (The Incidental Economist, May 2013), http://theincidentaleconomist.com/wordpress/oregon-medicaid-experiment-is-a-rorschach-test-of-peoples-views-of-the-aca/
Letter from Governor Asa Hutchinson to Secretary Burwell (Dec. 29, 2015), http://posting.arktimes.com/media/pdf/asaletter.pdf.
Peter Damiano, Suzanne Bentler, Mark Pooley, Susan McKernan, Elizabeth and Momany, Non-Emergency Transportation Services for IHAWP Members: The early experiences of Iowa Health and Wellness Plan members (Iowa City, Iowa: University of Iowa Public Policy Center, March 2015), http://dhs.iowa.gov/sites/default/files/NEMT_Brief_IHAWP_Early_Experiences_042015.pdf
Sayeh Nikpay, Thomas Buchmueller, and Helen Levy, “Affordable Care Act Medicaid Expansion Reduced Uninsured Hospital Stays in 2014,” Health Affairs 35, no.1 (2016):106-110, http://content.healthaffairs.org/content/35/1/106.full.html
The Stephens Group, Status Report #2 on Health Care Reform/Medicaid Consulting Services for the Arkansas Health Reform Task Force (Manchester, New Hampshire: The Stephen Group, July 2015), http://ee-governor-2015.ark.org/images/uploads/TSG-1_June_report-No.2-corrected_7-16_version.pdf.
Jocelyn Guyer, Naomi Shine, MaryBeth Musumeci, and Robin Rudowitz, A Look at the Private Option in Arkansas (Washington, D.C.: Kaiser Family Foundation, August 2015), https://www.kff.org/medicaid/issue-brief/a-look-at-the-private-option-in-arkansas/
Benjamin Sommers, Robert Blendon, and E. John Orav, “Both The “Private Option” And Traditional Medicaid Expansions Improved Access to Care For Low-Income Adults,” Health Affairs, 35, no.1 (2016):96-105, http://content.healthaffairs.org/content/35/1/96.full.html
