KFF designs, conducts and analyzes original public opinion and survey research on Americans’ attitudes, knowledge, and experiences with the health care system to help amplify the public’s voice in major national debates.
The dominant forces shaping Medicaid during FY 2013 and heading into FY 2014 were the implementation of the Affordable Care Act (ACA) and the development and implementation of an array of delivery and payment system reforms. These changes represent some of the most significant changes to Medicaid since its enactment in 1965, and taken together, are transforming the role of Medicaid in the health care system in each state. At this time, the intensity of fiscal pressures and the focus on cost Medicaid containment were somewhat lessened as the economy slowly recovers; however, controlling costs and improving program administration are still important priorities for Medicaid program. The findings in this report are drawn from the 13th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA). The report highlights trends in Medicaid spending, enrollment and policy initiatives for FY 2013 and FY 2014 with an intense focus on eligibility and enrollment changes tied to the implementation of the ACA as well as payment and delivery system changes. The report provides detailed appendices with state-by-state information and a more in-depth look at four case study states: Arizona, Florida, Kentucky and Washington. Key findings from the survey include the following:
Improvements in the economy resulted in modest growth in Medicaid spending and enrollment in FY 2013. In FY 2014, national enrollment and spending growth are expected to rise. States moving forward with the Medicaid expansion are expected to see higher enrollment and total spending growth driven by increases in coverage and federal funds.
The implementation of the ACA will result in major changes to Medicaid eligibility and enrollment for all states whether they are implementing the ACA Medicaid expansion or not.
Nearly all states are developing and implementing payment and delivery system reforms designed to improve quality, manage costs and better balance the delivery of long-term services and supports across institutional and community-based settings.
Improvements in the economy have enabled states to implement more program restorations or improvements in provider rates and benefits compared to restrictions, but states also adopted policies to control costs and enhance program integrity.
Looking ahead, FY 2014 will be a transformative year for Medicaid.
U.S. support for global health and international humanitarian assistance efforts has grown over the last decade, but the mechanisms that staff, administer, and oversee each of these sectors have remained largely isolated and distinct from one another. While there are differences in the objectives and approaches of these two sectors, it is also true that their activities are integrally linked. Many times, the countries, communities and populations served by each are the same or closely overlap. In addition, there is a subset of countries where recurrent and chronic crises draw both significant U.S humanitarian and global health assistance year after year. As such, identifying opportunities for creating greater synergies and linkages between U.S. humanitarian and global health programs can help to improve longer-term health outcomes and increase the cost-effectiveness of U.S. investments.
While humanitarian actors have debated issues around linking the disaster response and longer-term development for decades, now may be an opportune moment for the U.S. to move the discussion forward and consider a more integrated, cooperative approach. Many donors and practitioners in the humanitarian sector are already focusing more on building “resilience” and reducing the risk of disasters through country-led plans, approaches that dovetail nicely with an increasing emphasis on country ownership and health systems strengthening by global health programs.
As a step toward understanding and addressing these issues, the Kaiser Family Foundation conducted an analysis of the policy and financing landscape at the intersection of these two sectors. The Foundation also convened a roundtable of experts in July 2013 for a policy discussion to explore the linkages between the U.S. humanitarian and global health sectors and responses, as well as to identify opportunities, challenges, and potential next steps for the U.S. government and others.
This summary document consists of two parts:
Part I presents the key findings from the Kaiser Family Foundation review and analysis of the policy and financing landscape where humanitarian assistance and global health assistance meet, with an emphasis on the U.S.
Part II summarizes the information shared and issues raised by participants during the July roundtable discussion, which focused on opportunities, challenges, and potential next steps for more effective coordination between humanitarian assistance and global health programs, for the U.S. government and others.
New Campaign From Greater Than AIDS Developed Locally With The San Francisco Department Of Public Health To Engage Gay And Bisexual Men In Response To HIV/AIDS
SAN FRANCISCO, Calif., October 4, 2013 – Greater Than AIDS, a leading national public information response to the domestic epidemic, today launched Speak Out, a new campaign developed locally with the San Francisco Department of Public Health to engage gay and bisexual men in response to HIV/AIDS and confront the silence and stigma that too often surrounds the disease. An overarching theme of the cross-platform campaign is to encourage more open communication about HIV in relationships, with health care providers and within the community generally.
In a provocative series of outdoor ads that begin appearing around the city this month, including a media “take over” of the Castro MUNI station, a diverse group of gay men, both positive and negative, open up about HIV in the gay community and why it continues to be so hard to talk about. With the tagline, “What You Say Matters,” the men’s unvarnished comments bring attention to the stigma and silence that too often still surrounds HIV.
In “Let’s Bring HIV Out of the Closet,” an online signature video (0:06 minute) produced for the campaign, the men open up about how HIV has affected their lives and those around them. In this intimate and candid conversation, the men talk about the growing silence about HIV, the stigma that exists within the gay community around the disease and what needs to happen to address it. The video is being distributed on the web and through social media and promoted through other elements of the campaign.
“Speak Out is about bringing the energy and momentum of the gay movement to bear once again on HIV/AIDS,” said Tina Hoff, Senior Vice President and Director of Health Communications and Media Partnership, Kaiser Family Foundation, a founding partner of Greater Than AIDS. “More than 30 years since the epidemic began gay and bisexual men continue to be among those most affected by HIV. It doesn’t have to be this way.”
Through targeted media messages and complementary community outreach, Speak Out encourages more open communication about HIV in all aspects of life, including:
SPEAK OUT For Our Relationships. Talking with friends and lovers about HIV, including using protection, getting tested together, and discussing HIV status.
SPEAK OUT For Our Health. Asking to be tested, talking about treatment options and seeking support when needed.
SPEAK OUT For Our Community. Confronting stigma and addressing misconceptions through open communication with the people in our lives.
“Speak Out is an opportunity to engage the Gay community to speak out around knowing their status, the importance of getting tested at least every six months, and getting into care and treatment”. It is about finding our voice again in our community to ensure that we all find an healthy way to take care of ourselves,” Vincent Fuqua, Health Program Coordinator, SFDPH, Community Health Equity and Promotion.
Nationally, gay and bisexual men account for the majority (56%) of the more than 1.1 million people living with HIV today in the U.S., and two thirds (66%) of new HIV infections. In San Francisco, gay and bisexual men account for an even greater share of the local epidemic, representing 88% of all persons living with HIV in the city and 82% of new infections.
Whether HIV positive or negative, the campaign stresses the role of the community as a whole in addressing HIV/AIDS, including promoting increased routine testing for gay men as recommended by the San Francisco Department of Health and linkage to care and treatment.
SF>AIDS. While San Francisco is leading the nation on many indicators, the overall rate of new infections among gay and bisexual men (referred to as men who have sex with men or MSM) is still very high and HIV remains a serious threat for MSM in the city. As of 2011, overall HIV prevalence among the share of MSM who do not inject drugs is estimated at more than one in five (22.7%).
Testing rates have been increasing in San Francisco according to recent data, yet still many MSM in the city are not being tested as routinely as recommended (every 3-6 months). According to a 2011 survey, 40% of sexually active MSM who were not already diagnosed as HIV positive in San Francisco had not been tested in the previous 6 months. Also of concern is the share of men who are HIV positive who are not in care and on treatment following diagnosis. Only half of HIV cases reported in San Francisco between 2008 and 2010 had viral suppression within one year of diagnosis.
Greater Than AIDS is a leading national public information response focused on the U.S. domestic epidemic. Launched in 2009, it is supported by a broad coalition of public and private sector partners, including: major media and other business leaders; Federal, state and local health agencies and departments; national leadership groups; AIDS service and other community organizations; and foundations, among others.
Through targeted media messages and community outreach, Greater Than AIDS works to increase knowledge, reduce stigma and promote actions to stem the spread of the disease. While national in scope, Greater Than AIDS focuses on communities most affected
The Kaiser Family Foundation – a leader in health policy and communication – provides strategic direction and day-to-day management, as well as oversees the production of the campaigns. The Black AIDS Institute – a think tank exclusively focused on AIDS in Black America – provides leadership and expert guidance and supports community engagement. Additional financial and substantive support is provided by the Elton John AIDS Foundation, Ford Foundation and MAC AIDS, among others.
This first of three case studies examining key operational aspects of coordinated care initiatives in Medicaid focuses on Colorado’s Medicaid reform initiative, known as the Accountable Care Collaborative (ACC), and a contract for data analytics that is fundamental to it. The Statewide Data Analytics Contractor (SDAC) is responsible for providing actionable data, through a web portal, to primary care providers and regional care collaborative organizations. The data analytics and resources the SDAC provides, including performance, cost, and utilization metrics, and other data tools, are essential to the state’s efforts to drive improvement in care management and in Medicaid patient as well as community health, and to support the accountable care model.
Obamacare creates several new ways to get health coverage. If you are not offered health coverage through your job, you may be able to obtain it through Medicaid or through a new health insurance marketplace (or exchange) in your state.
New Coverage Options
By filling out a single application, you’ll learn your plan options and costs, and whether you qualify for coverage through Medicaid or help purchasing coverage in the new insurance marketplace for your state. You may qualify for Medicaid if you earn less than about $16,000 a year or less as a single individual, even if you are an adult without children at home who previously was not eligible for Medicaid coverage. Other family sizes can qualify at higher income. However, states are not required to expand Medicaid and more than two dozen are unlikely to move forward.
If you earn too much to be eligible for Medicaid, you may still be able to get affordable coverage in the new marketplaces. Whether state-based or federal, these marketplaces will serve as an online store where you can shop for health insurance plans offered by private insurance companies in your area. Insurance plans will come in four levels – bronze, silver, gold and platinum – that will vary in what they cover, what they charge in premiums and what deductibles and other out-of-pocket costs they require. If you are under 30, you may be able to get a “catastrophic” insurance plan that charges lower premiums but requires that you pay more of your own medical bills before coverage kicks in. You cannot be denied coverage because of a pre-existing condition and may need to obtain coverage to avoid paying a penalty.
Financial Assistance
Depending on your income, you may be eligible for federal assistance that will lower the premiums you pay and reduce how much money you must pay out of your own pocket when you seek medical care. In general, a single person with an annual income between about $11,500 and $46,000, or a household with income between $19,500 and $78,000 for a family of three, can get help if coverage is purchased through the marketplace. The range will differ for families of different sizes. Use the Kaiser Family Foundation’s online calculator to get a rough estimate of the premiums and subsidies that may be available to you.
You can start applying for coverage that takes effect in January 2014 during the “open enrollment” period that runs from Oct. 1 through March 31. If you need help with the application there will be people who can assist you. A list of assisters near you should be available on the insurance marketplace website in your state. If you qualify for Medicaid, you can enroll at any time, not just during open enrollment.
If you don’t get coverage you may have to pay a penalty. The minimum penalty will be $95 in 2014, but could reach thousands of dollars depending on your income. Some people won’t have to pay the penalty even if they don’t have coverage. This includes anyone uninsured for less than three months, people who do not have to file a federal tax return, and people who would have qualified for Medicaid but their state decided not to expand the program, among others.
Questions
The federal government has set up a toll-free 24-hour hotline — 1-800-318-2596 — to handle consumers’ questions. To find out more about Obamacare visit www.healthcare.gov.
This fact sheet is also available in Spanish: en español.
If you have Medicare, you will not have to make any changes to your health insurance coverage as a result of Obamacare. You can continue to rely on Medicare to help pay your hospital, physician and other medical expenses.
You will still have the option to choose between traditional Medicare or a Medicare Advantage plan (such as a Medicare HMO) offered in your area, and among Medicare prescription drug plans. If you are on Medicare, and low income, you may also qualify for extra help with premiums and cost sharing. The law did not change these options. For more information about your Medicare coverage options, you can visit http://www.medicare.gov or call the 1-800-MEDICARE help line.
Improvements to Medicare Benefits
The health reform law made some significant improvements to Medicare’s benefits that may help you:
Medicare no longer requires you to pay a fee for an annual checkup from your doctor.
Medicare no longer charges a fee for many preventive screenings for cancer, depression, diabetes, cholesterol, obesity, and other conditions.
Medicare is gradually reducing the amount of money people who have very high prescription drug costs have to pay each year, by closing a gap in coverage, sometimes called the “doughnut hole.”
Other Medicare Changes
Most of the other changes to Medicare affect how Medicare pays health insurance companies, hospitals and other health care providers for the care received by people on Medicare. For example, the law reduced what Medicare pays HMOs and other private Medicare Advantage plans. Other changes are designed to get hospitals, doctors and other health care providers to improve the quality of care they provide for people on Medicare, such as by encouraging providers to work more closely together to coordinate care for patients when they are discharged from the hospital and by taking steps to prevent unnecessary hospital readmissions. Most of these efforts are in the early stages, and it will take time to see what kind of impact they have.
The law also includes new fees for people on Medicare with relatively high incomes. If you are single and your income is more than $85,000 annually or you are married and your income is more than $170,000 annually, you may pay higher Medicare premiums.
Questions
To find out more about Medicare, visit www.medicare.gov or call 1-800-MEDICARE. To find out more about Obamacare, visit www.healthcare.gov or call the federal government’s toll-free 24-hour hotline – 1-800-318-2596 .
This fact sheet is also available in Spanish: en español.
If you or someone in your family has a pre-existing health condition – such as heart disease, asthma, or even a pregnancy – you will find it much easier to obtain coverage or change plans starting in 2014. Obamacare bars insurers from denying coverage to people with pre-existing conditions, or physical or mental illnesses or conditions that existed before coverage began. Insurers also can no longer refuse to pay for otherwise-covered medical care and services due to a pre-existing condition or charge you more because of a pre-existing condition in the family.
What’s Covered
If you don’t have insurance or want to change plans, you can shop for a new plan in the individual insurance market or on your state’s new health insurance marketplace (or exchange). These plans will cover doctor visits, hospitalization, prescription drugs and maternity care without any restrictions for pre-existing conditions. They will cover preventive services like immunizations, screenings and contraception at no expense to you. You will not have to give your detailed health or medical history to apply. The marketplaces will allow you to compare plans and prices. The open enrollment period for your state’s marketplace will run from Oct. 1 through March 31. Coverage begins on Jan. 1, 2014.
Types of Plans
Plans both in and out of the marketplace will come in four levels – bronze, silver, gold and platinum – that will vary in what they cover, what they charge in premiums and what deductibles and other out-of-pocket costs they require. But these plans cannot charge you more based on your medical history. Insurers can only vary their premiums based on your age, the number of people in your family covered by the policy and whether you use tobacco.
Help with Premiums
If you buy a policy through your state’s marketplace, you may also be eligible for financial assistance to help cover the cost. In general, you may be eligible if you are a single person with an annual income in the range of $11,500 to $46,000, or if your household income is in the range of $19,500 to $78,000 for a family of three. The range will differ for families of different sizes. Use the Kaiser Family Foundation’s online calculator to get a rough estimate of the premiums and subsidies available to you. People with lower incomes who buy coverage through the marketplaces also may have their deductibles and other out-of-pocket costs reduced. If your income is lower, you may be eligible for coverage through Medicaid.
Other Options
Obamacare established a temporary program in 2010 to offer coverage to people with pre-existing conditions. If you have coverage through the Pre-existing Condition Insurance Plan in your state, you can remain enrolled through the end of January 2014, but are encouraged to get coverage in your marketplace as soon as possible.
If you currently have insurance you purchased on your own (and not through an employer), then the plan may be exempted from the law’s requirements about pre-existing conditions. However, you can still drop that coverage and buy one under the new rules.
Questions
The federal government has set up a toll-free 24-hour hotline – 1-800-318-2596 – to answer consumers’ questions. To find out more about Obamacare visit www.healthcare.gov.
This fact sheet is also available in Spanish: en español.
If you are now covered by job-based health benefits through your (or a family member’s) employer, then you likely can keep that coverage and will not have to make any changes. In most cases, your employer coverage will satisfy the law’s requirement that you obtain insurance.
Changes to Employer Coverage
Some features of your employer coverage may already have changed as a result of the law. For example, if you are a parent, your children may now stay on your policy until they reach age 26.
Your plan also now likely covers preventive services like immunizations and screenings at no cost to you, though some employer plans in place in 2010 are exempted from this requirement.
Beginning in 2014, your plan cannot set an annual dollar limit on your benefits that could leave you without coverage if you get seriously ill. Your plan also can no longer limit anyone’s coverage for pre-existing conditions. Your plan also can no longer limit the total dollar amount of benefits you may receive over your lifetime. Employer plans are also required to limit the amount of cost sharing (such as deductibles and co-pays) that you are required to pay for covered services to $6,350 per person per year. This provision will take full effect in 2015.
In some cases, your employer may need to change your health benefits to meet the law’s requirements. For instance, if you currently get only bare-bones coverage through your employer — such as help paying for routine doctor visits, with little or no coverage for hospitalization of other serious illnesses — that coverage can no longer be offered in 2014. Your employer may decide to offer more comprehensive coverage, as most employers already do, or your employer may decide not to offer any coverage to its workers.
Employer Mandate
The law encourages employers to offer health insurance. Large employers — those with at least 50 full-time workers (or the equivalent in part-time workers) may face penalties if they do not offer affordable coverage to full-time workers. These penalties will begin in 2015, a year later than originally called for in the law. Smaller employers — those with 50 or fewer full-time workers — are not required to offer coverage, but may get tax credits if they do.
If your employer offers coverage that is too costly for you to afford based on your income, you may want to buy coverage through the new health insurance marketplace (or exchange) in your state instead. The marketplaces are like an online store for people buying their own health insurance and would allow you to compare plans based on price and other factors. You may qualify for tax credits to purchase this coverage if your employer does not offer you coverage that meets the law’s requirements and your household income falls below a certain level — about $46,000 for an individual or $78,000 for a family of three. If your income is very low (less than about $16,000 for a single individual) you might also qualify for coverage under Medicaid.
Questions
The federal government has set up a toll-free 24-hour hotline – 1-800-318-2596 – to answer consumers’ questions. To find out more about Obamacare, visit www.healthcare.gov.
This fact sheet is also available in Spanish: en español.
Obamacare and You is a series of one-page papers explaining how the Affordable Care Act, also known as “Obamacare,” will affect different groups of people. Click on the links below to learn more:
The Kaiser Family Foundation partnered with NBC News to ask several survey questions of the U.S. public about their feelings towards the 2010 health care law, as well as their worries about affording health care more generally. These questions were asked as part of the September 2013 Kaiser Health Tracking Poll.
