This report presents data on changes in Medicaid’s enrollment and spending between federal fiscal year 2007 and federal fiscal year 2011, a period which includes the worst economic downturn in the United States since the Great Depression of the 1930s. The paper also examines what factors drove Medicaid spending over the period, and concludes that overall spending growth from 2007 to 2011 was driven largely by the enrollment growth that resulted from many people losing jobs and income during the recession. However, on a per enrollee basis, Medicaid spending has grown more slowly than other sectors of the health system.

Report (.pdf)

A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges.  Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have substantial consequences for health coverage for the low-income population. The 3 key questions that states should consider in evaluating the ACA Medicaid expansion are:

1. What are the fiscal implications of the ACA Medicaid expansion for states?

• Overall, many states are likely to see net savings from the Medicaid expansion.
• The Medicaid expansion also may have positive economic effects for states like increased jobs, revenues or economic activity.
• Studies show that the Medicaid expansion could increase revenues to hospitals, offsetting hospital reimbursement reductions that were also included in the ACA.
• Some states are concerned about federal deficit reduction efforts and the implications for Medicaid; however, the FMAP formula that determines the federal share of Medicaid spending has remained steady since the start of the program.  Congress has only amended the formula to provide more federal funding, not less.

2. What effect will the Medicaid expansion have on coverage? 

• The Medicaid expansion would make health care coverage available to millions of low-income adults and significantly reduce the number of uninsured.
• A large body of research shows that Medicaid increases access to care and limits out-of-pocket burdens for low-income people.  Despite claims to the contrary, research points to improved outcomes and reduced mortality from Medicaid coverage.
• Actions to address workforce challenges and low provider participation in Medicaid will be important to improve access with the Medicaid expansion.
• For most states that do not implement the ACA Medicaid expansion, there will be large gaps in coverage for low-income individuals because individuals with incomes below poverty are not able to access subsidies to purchase coverage in in the new health insurance exchanges.

3. What flexibilities do states have in implementing the Medicaid expansion?

• States have considerable flexibility to administer traditional Medicaid programs.
• Under the ACA Medicaid expansion, states have flexibility around benefits, cost sharing as well as how to deliver and pay for care.
• Proposals are emerging that would allow states to purchase exchange coverage for Medicaid expansion enrollees through premium assistance options.
• States also continue to have ability to seek approval for demonstration waivers.  Beginning in 2017, 1115 waivers may be combined with State Innovation Waivers.

1. What are the fiscal implications of the ACA Medicaid expansion for states?

Overall, many states are likely to see net savings and positive effects from the Medicaid expansion. The ACA expands Medicaid to a national eligibility floor of 138% of the federal poverty level (FPL) and provides 100% federal financing for those newly eligible for Medicaid from 2014 through 2016.  The federal contribution phases down to 90% and by 2020 and beyond.  A report prepared by the Urban Institute for the Kaiser Commission on Medicaid and the Uninsured estimates that if all states expanded Medicaid, the total cost of the expansion would be about $1 trillion over the 2013-2022 period with the federal government paying $952 billion (93%) and the states paying $76 billion.¹  States costs are related to increased participation among those currently eligible for coverage (reimbursed at the traditional Medicaid match rate) and a small share for those newly eligible (up to 10% by 2020).  Increased participation in Medicaid is likely to occur due to national outreach and enrollment activities as well as provisions that are in place even a state chooses not to implement the ACA Medicaid expansion including requirements to simplify and streamline the enrollment process and to coordinate enrollment across health programs (Exchange, Medicaid and CHIP).

States are also likely to see savings or offsets to costs from the Medicaid coverage expansion from:  reduced state spending for uncompensated care; transitioning current Medicaid coverage for specific groups (such as Breast and Cervical cancer targeted coverage) to “newly eligible” coverage at the higher match rates; transitioning current Medicaid coverage to individuals with incomes above 138% FPL to coverage in the exchange; or reduced spending for programs that serve indigent populations (such as  state funded mental health or substance abuse programs).  States could also see revenue from broader economic effects of the Medicaid expansion such as increased jobs, income and state tax revenues at the state level within the health care sector and beyond due to the multiplier effect of spending.

Studies show that the Medicaid expansion could increase revenues to hospitals, offsetting hospital reimbursement reductions that were also included in the ACA.  Hospitals and other provider groups are also likely to benefit from the Medicaid expansion due to increase revenues to hospitals tied to new coverage.  The Urban analysis estimates an increase of nearly $300 billion over the 2013-2022 period – a 23% increase in Medicaid reimbursement for hospitals.²   A recent analysis shows these new revenues are likely to offset other reductions to providers under the ACA such as Medicare and Medicaid cuts to Disproportionate Share Hospital (DSH) payments.³   The ACA cuts to DSH payments will go forward even if states do not implement the Medicaid expansion.  In these states, the revenues from the expansion will not offset these cuts.  Managed Care Organizations (MCOs) could also benefit from additional revenues from the Medicaid expansion as states are expected to continue to use managed care to serve the Medicaid expansion population.

Some states are concerned about federal deficit reduction efforts and the implications for Medicaid; however, the FMAP formula that determines the federal share of Medicaid spending has remained steady since the start of the program.  Congress has only amended the formula to provide more federal funding, not less. States have often cited risks related to changes in the federal commitment to financing the Medicaid expansion.  While there is some concern that federal deficit reduction efforts could affect Medicaid, the history of Medicaid financing points to a matching formula that has been stable with only a few temporary adjustments to the formula have resulted in FMAP increases (like increases under the American Recovery and Reinvestment Act), not decreases.   A number of states have language in their proposals to expand Medicaid to safeguard against any declines in federal support.

2. What effect will the Medicaid expansion have on coverage? 

The Medicaid expansion would make health care coverage available to millions of low-income adults and significantly reduce the number of uninsured.  The Medicaid expansion would make millions of low-income uninsured adults newly eligible for the program. Nationally, over half of the non-elderly uninsured have incomes below 138% FPL ($15,856 annually in 2013). If all states implement the Medicaid expansion, Medicaid enrollment could increase by 21.3 million.⁴   The Medicaid expansion, together with other provisions in the ACA, could cut the number of uninsured in half.  If states do not implement the expansion, poor adults in these states will be left without affordable coverage options and will continue to face the health and financial consequences of being uninsured.

A large body of research shows that Medicaid increases access to care and limits out-of-pocket burdens for low-income people. A large body of research shows that Medicaid increases access to care. Children and adults enrolled in Medicaid have much better access to care than the uninsured. On key measures of access to preventive and primary care, Medicaid enrollees fare as well as people with private health insurance. Medicaid’s limits on cost‐sharing help to ensure that cost is not an obstacle to obtaining care and Medicaid beneficiaries are far less likely to face high financial burdens for health care than low‐income people with private insurance. ⁵   A recent and seminal study in Oregon shows that Medicaid increased the likelihood of using outpatient care, inpatient services and prescription drugs, and recommended preventive care.  Medicaid increases the probability of individuals having a usual source of care. ⁶ , ⁷ 

Actions to address workforce challenges and low provider participation in Medicaid will be important to improve access with the Medicaid expansion. Although access to primary care in Medicaid is quite robust, many states report challenges to ensuring enough providers, including dental and specialty providers, to serve Medicaid beneficiaries.  Increased state outreach to providers, higher and quicker payment, and streamlined enrollment and billing processes for providers may help foster increased participation.  States could also seek to increase the supply of providers willing to serve Medicaid patients by liberalizing scope-of-practice laws related to nurse practitioners and dental therapists.  But closing access gaps is also a matter of workforce planning and investment (e.g., training more primary care physicians, and developing a more diverse workforce) that states may have limited levers to influence and are relevant for Medicaid as well as other payers.

Often cited claims regarding poor quality in Medicaid run contrary to the weight of evidence from studies that point to improved outcomes and reduced mortality from Medicaid coverage. Research from a broad set of literature has found that expansions of Medicaid to children and pregnant women have led to improved child health and birth outcomes.⁸   Studies also found that Medicaid expansion for adults were associated with significant reduction in mortality compared to states without a similar Medicaid expansion.⁹  The Oregon Health Study also showed improvements in measures of self-reported physical and mental health.¹⁰ 

For most states that do not implement the ACA Medicaid expansion, there will be large gaps in coverage for low-income individuals because individuals with incomes below poverty are not able to access subsidies to purchase coverage in in the new health insurance exchanges.  Individuals with incomes below 100% FPL ($11,490 annually in 2013) generally cannot receive subsidies to purchase coverage in the newly established health insurance exchanges and will not gain any new affordable coverage options and continue to face the consequences of being uninsured.    This could leave individuals with higher incomes access to health coverage options while leaving those with lower incomes few or no options for affordable coverage.  People of color will be disproportionately impacted if states do not implement the expansion.¹¹ 

3. What flexibilities do states have in implementing the Medicaid expansion? 

States continue to have considerable flexibility to administer traditional Medicaid programs.  States have a great deal of flexibility to administer their current Medicaid programs.  In guidance issued on December 10, 2012,¹²  the Administration highlighted new flexibility available to states such as:  structuring payments to better incentivize higher-quality and lower-cost care; ability to use cost-sharing, enhanced matching funds for health home care coordination services for those with chronic illnesses; new templates to make it easier to submit section 1115 demonstrations and to make it easier for a state to adopt selective contracting in the program; and a new tool to help support states interested in extending managed care arrangements to long term services and supports.  CMS is also working with states to improve data analytics and value-based purchasing.

Under the ACA Medicaid expansion, states have flexibility around benefits, cost sharing as well as how to deliver and pay for care.  The December 10, 2012 guidance also highlighted requirements and new flexibility for the Medicaid expansion group.  For example, the guidance specified that states could not receive enhanced ACA matching funds to expand coverage to levels lower than 138% FPL, but states can choose a benefit package benchmarked to a commercial package or design an equivalent package.  The guidance also stated that the federal government would review state proposals for the Medicaid expansion population that encourage personal responsibility, promote value and individual ownership in health care decisions as well as accountability tied to improvement in health outcomes.  Proposed regulations issued in January 2013 included changes that would allow for additional flexibility around cost sharing, particularly related to non-preferred drugs and non-emergent care in the emergency room.  States also will continue to have flexibility to determine how to deliver care (i.e. through managed care, fee-for-service or a combination of approaches).  About two-thirds of current Medicaid enrollees access care through private managed care arrangements and most states would continue to expand these arrangements for new Medicaid enrollees.

Proposals are emerging that would allow states to purchase exchange coverage for Medicaid expansion enrollees through premium assistance options.¹³   CMS recently issued a set of FAQs affirming that states would not be able to implement partial expansions, that premium assistance programs would still need to ensure Medicaid protections related to benefits and cost sharing and that the Secretary of HHS would approve a limited number of 1115 demonstration waivers through 2016 that meet certain criteria.¹⁴  Arkansas is likely to pursue this demonstration option.

States also continue to have ability to seek approval for demonstration waivers.  Beginning in 2017, 1115 waivers may be combined with State Innovation Waivers.  As under current law, states also retain the ability to apply for Section 1115 demonstration waivers to test new approaches in Medicaid that differ from federal program rules.  It is an open question about what type of proposals will be offered by states and approved by the Secretary.  The December guidance specified that HHS would not consider partial expansions for populations eligible for the 100 percent matching rate in 2014 through 2016. Waivers for partial expansion would be considered at the regular Medicaid match rates.  In 2017, when the 100 percent federal funding is slightly reduced, further demonstration opportunities will become available to states under State Innovation Waivers with respect to the Exchanges, and the law contemplates that such demonstrations may be coupled with section 1115 Medicaid demonstrations. 1115 Medicaid demonstrations, with the enhanced federal matching rates, would be considered in the context of these overall system demonstrations.

1. John Holahan, Matthew Beuttgens, Caitlin Carroll and Stan Dorn, The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis.  Kaiser Commission on Medicaid and the Uninsured, November 2012.  http://modern.kff.org/medicaid/report/the-cost-and-coverage-implications-of-the/ ↩︎
2. Ibid. ↩︎
3. State Dorn, Matthew Buettgens,  John Holahan, and Caitlin Carroll, The Financial Benefit to Hospitals from State Expansion of Medicaid.  March 2013.  http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/03/the-financial-benefit-to-hospitals-from-state-expansion-of-medic.html?cid=xem_259medicaidB&cid= ↩︎
4. John Holahan, Matthew Beuttgens, Caitlin Carroll and Stan Dorn, The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis.  Kaiser Commission on Medicaid and the Uninsured, November 2012.  http://modern.kff.org/medicaid/report/the-cost-and-coverage-implications-of-the/ ↩︎
5. Medicaid:  A Primer.  Kaiser Commission on Medicaid and the Uninsured, June 2010.  http://modern.kff.org/medicaid/issue-brief/medicaid-a-primer-2010/ ↩︎
6. Amy Finkelstein, MIT and NBER; Sarah Taubman, NBER;, Bill Wright, CORE; Mira Bernstein, NBER; Jonathan Gruber, MIT and NBER; Joseph P. Newhouse, Harvard and NBER; Heidi Allen, CORE; Katherine Baicker, Harvard and NBER; and the Oregon Health Study Group. The Oregon Health Insurance Experiment: Evidence from the First Year. NBER Working Paper No. 17190.  Issued in July 2011. http://www.nber.org/papers/w17190. ↩︎
7. This study is based on a randomized control trial (the gold standard for study methodology), which avoids many of the problems with causation and confounding in observational studies. ↩︎
8. Medicaid:  A Primer.  Kaiser Commission on Medicaid and the Uninsured, June 2010.  http://modern.kff.org/medicaid/issue-brief/medicaid-a-primer-2010/ ↩︎
9. Sommers BD, Baicker K, and Epstein AM. “Mortality and Access to Care among Adults after State Medicaid Expansions.” New England Journal of Medicine. 2012; 367:1025-1034. ↩︎
10. This study is based on a randomized control trial (the gold standard for study methodology), which avoids many of the problems with causation and confounding in observational studies. ↩︎
11. Health Coverage by Race and Ethnicity: The Potential Impact of the Affordable Care Act.  Kaiser Commission on Medicaid and the Uninsured, March 2013.  http://modern.kff.org/uncategorized/issue-brief/health-coverage-by-race-and-ethnicity-the-potential-impact-of-the-affordable-care-act/ ↩︎
12. http://medicaid.gov/State-Resource-Center/Frequently-Asked-Questions/Downloads/Governor-FAQs-12-10-12.pdf ↩︎
13. Premium Assistance in Medicaid and CHIP: An Overview of Current Options and Implications of the Affordable Care Act.  Kaiser Commission on Medicaid and the Uninsured, March 2013.  http://modern.kff.org/medicaid/8422.cfm ↩︎
14. Affordable Care Act:  Premium Assistance FAQ.  CMS available at:  http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/FAQ-03-29-13-Premium-Assistance.pdf  ↩︎

With the open enrollment period for health insurance exchanges less than six months away, consumers are already asking questions about their new health care options under the Affordable Care Act (ACA). Even in the age of digital information, hands-on consumer assistance could play a key role in helping people understand their insurance choices come 2014 — a recent Kaiser Family Foundation poll showed that two thirds of the uninsured and a majority of Americans overall say they have too little information to know how the ACA will affect them.

This brief outlines the need for hands-on consumer assistance, the resources available under the ACA to fill this need, and the implementation issues that may impact the effectiveness of consumer assistance efforts. It lays out specific situations that may cause confusion for consumers, such as determining eligibility for subsidies; distinguishes between different sources of consumer assistance; and identifies factors that vary from state to state that could influence the effectiveness of these efforts.

Issue Brief (.pdf)

With the open enrollment period for health insurance exchanges less than six months away, consumers are already asking questions about their new health care options under the Affordable Care Act (ACA). Even in the age of digital information, hands-on consumer assistance could play a key role in helping people understand their insurance choices come 2014 — a recent Kaiser Family Foundation poll showed that two thirds of the uninsured and a majority of Americans overall say they have too little information to know how the ACA will affect them.

This brief discusses some of the key policy decisions states are making and briefly describes these programs in a handful of states. This brief is not intended to offer comprehensive examination of all state activity, but rather provides a snapshot of key decisions in a few states. States were included in this snapshot if they had released a detailed RFP or other policy documents describing how these assistance programs would be structured.

Issue Brief (.pdf)

This fact sheet highlights key issues about Medicaid, including the structure, financing and purpose of the program, its role for low-income beneficiaries, its share of the federal budget and state budgets and the significant implications of the coverage expansion under the Affordable Care Act.

Fact Sheet (.pdf)

Related chartpack: Medicaid and Its Role in State/Federal Budgets and Health Reform

This chartpack from the Kaiser Commission on Medicaid and the Uninsured addresses five key questions about the Medicaid program. They include:

• What is Medicaid and what does it do?
• What does Medicaid cost and why?
• What is Medicaid’s role in state budgets?
• What is Medicaid’s role in the federal budget?
• What is Medicaid’s role in health reform?

Chartpack (.pdf)

Related fact sheet: Medicaid and Its Role In State/Federal Budgets and Health Reform

• White House Senior Advisor Valerie Jarrett, U.S. Rep. Barbara Lee Discuss Impact of HIV on Women.
• New Kaiser Report Shows Progress in Stemming New HIV Infections among Women in U.S., though Only a Quarter have Virus Suppressed with Treatment
• AIDS United Announces Community Grants Program to Support Efforts in Hard Hit Areas as Part of Response

Fourteen-time Grammy Award-winning artist and HIV advocate Alicia Keys took part in a briefing at the Kaiser Family Foundation’s Washington, D.C. offices on Monday morning to introduce EMPOWERED, a new campaign to reach women in the U.S. about HIV — developed in partnership with the Foundation as part of the Greater Than AIDS initiative. Ms. Keys leads the campaign and is featured in conversations with women living with HIV.

Of the more than 1.1 million people living with HIV in the U.S. today, one in four is a woman. Black women have been disproportionately affected, accounting for majority of new infections among women.

Ms. Keys, who has dedicated her advocacy work to the urgency of HIV/AIDS and has long spoken of the power of women said: “Women and girls have been affected by HIV since the start, but that impact has not been recognized. And as the sisters, mothers, daughters, and caregivers, we are the backbones of families, communities and entire societies. We will never see an AIDS-free generation without harnessing the power and strength of women.”

The cross-platform campaign includes: TV, radio, outdoor, print and digital public service ads; special programming and editorial content; social media promotions and informational resources. In an effort to increase public dialog about HIV/AIDS, a half-hour video of Ms. Keys in conversation with women living with HIV is available for community screenings and discussion.

The Foundation released a new report on Women & HIV/AIDS in the U.S. that puts a spotlight on the epidemic today — in particular the crisis facing Black women. Despite recent encouraging trends showing a decrease in new infections among women in the U.S. — the most significant in two decades — HIV/AIDS continues to severely and disproportionately affect women of color who account for the majority of new infections among women. One in 32 Black women today is estimated to contract HIV in her life time. Just 26 percent of women who are HIV positive are in treatment and have the virus suppressed with ongoing antiretroviral therapy.

“Focusing our efforts on communities and populations where there is greatest need is the key to making greater progress on HIV,” said Drew E. Altman, President and CEO of the Foundation, adding that “EMPOWERED does that by focusing on women and HIV and the broader role women play in the response to the epidemic.”

Also as part of the EMPOWERED campaign, Alicia Keys announced her new community grants program to help advance community-level efforts focused on women and HIV/AIDS. The grants program will be administered by AIDS United with assistance from the Kaiser Family Foundation. Grants will be awarded via a competitive process steered by an advisory council comprised of leaders in the HIV field – representing the community, academia, and the private sector.

“We are taking action to help our most vulnerable populations of women protect themselves — and those they love — from continuing the spread of the virus and helping to create an AIDS-free generation in America,” said Dr. Vignetta Charles, Senior Vice President at AIDS United, a national organization supporting more than 400 local AIDS organizations.

On hand at Monday’s announcement to discuss the impact of HIV on women in the U.S. was White House Senior Advisor Valerie Jarrett — who chairs the President’s Council on Women and Girls and lost her sister-in-law to AIDS. Commenting on the progress of the President’s National HIV/AIDS Strategy, Ms. Jarrett said: “The role of this strategy is to prevent as many infections and save as many lives as possible, including reducing health disparities, improving health and wellness for everyone living with HIV.”

Congresswoman Barbara Lee (D-CA13), co-founding chair of the Congressional Caucus on HIV/AIDS, outlined policy priorities she sees facing the Congress in combatting HIV/AIDS, “Congress has an important role to play in creating and supporting legislation to empower women and to achieve an AIDS-free generation.”

The campaign spotlights conversation between Ms Keys and five HIV positive women from different parts of the country and walks of life. Among them are: Cristina, a graduate student from the San Francisco Bay Area who was born with HIV; Eva, a home health care worker living in Atlanta with her family; Kym, a young professional living in Texas who learned she was positive after her new husband became sick and died as a result of HIV; Jen, a wife and mother in the Pacific Northwest who has being living with HIV for over 20 years; and Stephanie, a recent college graduate from North Carolina who appeared in an MTV special on youth and HIV. They share their stories in the hopes of reaching other women and showing how, whether positive or negative, we are all empowered in this fight.

Tina Hoff, Senior Vice President and Director of the Health Communication and Media Partnerships program at the Foundation, commented: “Media campaigns, like EMPOWERED, play an important role as part of the public health response to HIV/AIDS by getting out information, connecting people in need with resources, keeping attention on the issue, and perhaps most significantly helping to confront the stigma that still surrounds the disease.”

An archived webcast from the event is available on the Kaiser Family Foundation website. For more information on EMPOWERED campaign, visit www.greaterthan.org/empowered.

About the Kaiser Family Foundation The Kaiser Family Foundation, a leader in health policy analysis, health journalism and communication, is dedicated to filling the need for trusted, independent information on the major health issues facing our nation and its people. The Foundation is a non-profit private operating foundation, based in Menlo Park, California. About Alicia Keys Alicia Keys is a 14 time Grammy Award®-winning singer/songwriter/producer, actress, New York Times best-selling author, entrepreneur and humanitarian. Since releasing her debut album, songs in A minor, Keys has built an unparalleled repertoire of hits with over 30 million albums sold worldwide. As an HIV advocate, Keys co-founded Keep a Child Alive (KCA) which provides AIDS treatment, support, nutrition and love to children and families affected by HIV/AIDS in Africa and India. About Greater Than AIDS Greater Than AIDS is a leading national public information response focused on the U.S. domestic epidemic. Launched in 2009 by the Kaiser Family Foundation and Black AIDS Institute, 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. About AIDS United The mission of AIDS United is to end the AIDS epidemic in the United States, through national, regional and local policy/advocacy, strategic grantmaking, and organizational capacity building. With partners throughout the country, AIDS United works to ensure that people living with and affected by HIV/AIDS have access to the prevention and care services they need and deserve.

This report maps the trajectory of the HIV/AIDS epidemic among women in the United States (U.S.), including the following:

• key historical epidemiological trends and the important role played by women in the response over time;
• the current impact of HIV among women in the U.S., including a profile of those most affected by race/ethnicity, age, transmission risk, geography, and other demographics;
• major sources of prevention, care, and treatment for women with and at risk for HIV;
• attitudes toward and knowledge about HIV among women; and
• ongoing challenges and opportunities.

While HIV has impacted women worldwide–globally, women comprise half of all those living with HIV–this report focuses on the impact of HIV on women in the U.S.

Report (.pdf)

The White House released the FY 2014 budget request, which included funding for U.S. global health activities.  Overall, funding for global health programs (at USAID and the State Department combined) increased in the FY 2014 request as compared to FY12 actual and FY13 estimated levels. This varied by specific global health program area (see below).

*FY13 are preliminary estimates that are likely to change. FY13 was calculated by using the FY13 Full-Year CR, which provided total GHP funding levels at USAID & State, applying a 0.032% across-the-board rescission (OMB estimate), and a 5% reduction due sequestration. For program estimates at USAID, the percentage increase in USAID funding between FY12 Final and FY13 CR was applied to each program area before applying reductions due to rescissions and sequestration.**In FY12, Congress approved $35m in funding for UNFPA. However, due to policy conditions put in place by Congress annually, the actual contribution to UNFPA totaled $30.2m.

Although relatively few Medicaid beneficiaries are in capitated managed long-term services and supports (LTSS) programs, significant expansion is anticipated as more than half of states are implementing or proposing new programs that would include a transition from fee-for-service (FFS) to capitated managed care in the LTSS delivery system. By definition, these Medicaid beneficiaries need assistance with activities of daily living. Thus poor transitions, particularly those that lead to gaps in services, can have dire consequences. This issue paper examines key policy and operational considerations related to the transition from FFS to risk-based capitated managed care for LTSS.

Issue Brief (.pdf)