Program on Medicaid and the Uninsured

This data note presents the latest state-level data about nonelderly Medicaid adults who have disabilities but do not quality for SSI and considers the implications for their continued coverage if the ACA expansion is invalidated by the Court.

As the Trump administration reaches the end of its first term, this issue brief considers the landscape of approved and pending Section 1115 Medicaid demonstration waivers under this administration and how the November 2020 presidential election may impact this landscape.

The repeal of the ACA could mean loss of Medicaid coverage for up to 15 million that were enrolled in the ACA Medicaid expansion group prior to the COVID-19 pandemic; however, repeal could also mean significant changes to Medicaid prescription drug policy with implications for state and federal spending for prescription drugs for non-expansion Medicaid enrollees.

In recent weeks, the possible overturning of the Affordable Care Act (ACA) in court and the upcoming election have focused attention on the issue of protections for people with pre-existing conditions. While the focus has been on the ACA’s private insurance protections, Medicaid also plays a significant role in covering people with pre-existing conditions.

This brief analyzes Medicaid enrollment and spending trends for FY 2020 and FY 2021 based on data provided by state Medicaid directors as part of the 20th annual survey of Medicaid directors in states across the country and the District of Columbia. After relatively flat enrollment growth in FY 2020, states responding to the survey expect Medicaid enrollment to jump in FY 2021, attributed to the Families First Coronavirus Response Act “maintenance of eligibility” (MOE) requirements and to the economic downturn that started late in FY 2020. Across all reporting states, states were anticipating that total Medicaid spending growth would accelerate in FY 2021 compared to FY 2020. Enrollment was the primary factor identified as putting upward pressure on expenditure growth in FY 2021.

This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. The findings are drawn from the 20th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by KFF and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). This report focuses on Medicaid policy changes planned for FY 2021, particularly those related to the COVID-19 pandemic.

U.S. Supreme Court decisions shape health policy in important ways. The nomination of Judge Amy Coney Barrett, if confirmed, is expected to establish a solid 6:3 conservative majority that could affect case outcomes in several areas. This issue brief considers the potential implications of a reconfigured Court for health policy issues, including those already on the Court’s docket for the coming term and those that the Court may choose to consider in this term or in the future.

The debate over filling the Supreme Court seat previously held by Ruth Bader Ginsburg has brought renewed attention to the possibility of the Affordable Care Act (ACA) being overturned under the court challenge in California v. Texas, currently scheduled to be heard shortly after the election this November. The expansion of Medicaid was a central component of the ACA, and 39 states have now adopted the ACA expansion into their Medicaid programs. Because Medicaid is administered by states, under federal guidelines, there may be some confusion about how overturning the federal law would affect state Medicaid programs.

This issue brief examines how the ACA Medicaid expansion has affected racial disparities in health coverage, access to care, health outcomes, and economic outcomes.

The Supreme Court will review the constitutionality of the Affordable Care Act (ACA) this November in California v. Texas. This fact sheet summarizes the major provisions of the ACA, illustrating the breadth of its changes to the health care system. If all of most of the ACA is struck down, many of these provisions could be eliminated.