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  • Medicaid in the Territories: Program Features, Challenges, and Changes

    Issue Brief

    This brief draws on a survey of and interviews with Medicaid officials in U.S. Territories, as well as other research, to examine key issues and trends in their Medicaid programs. Territories differ from the states on key demographic, economic, and health status indicators. Unlike in the states, where federal Medicaid funding is not capped, and the federal share varies based on states’ per capita income, Medicaid in the territories is subject to a statutory cap and a fixed federal matching rate.

  • Medicaid: What to Watch in 2019 from the Administration, Congress, and the States

    Issue Brief

    Medicaid, the provider of health insurance coverage for about one in five Americans and the largest payer for long-term care services in the community and nursing homes, continues to be a key part of health policy debates at the federal and state level. Important Medicaid issues to watch in 2019 include Medicaid expansion developments amid ongoing litigation about the ACA’s constitutionality as well as Medicaid demonstration waiver activities, including those focused on work requirements and other eligibility restrictions. States are also likely to continue to pursue initiatives to address the opioid crisis, and the recent passage of bi-partisan legislation with new tools and financing could bolster these efforts. Primary areas of federal policy to watch in 2019 with implications for Medicaid include the expiration of temporary funding for Puerto Rico and the US Virgin Islands in the absence of legislative action as well as potential regulatory changes to public charge policies that would likely lead to Medicaid enrollment declines among immigrant families. Finally, reforms in benefits, payment and delivery systems continue to evolve as states and the federal government focus on managed care, social determinants of health, prescription drugs, and community based long-term care. While beyond the scope of this brief, Congress and states could also consider broader health reform that could expand the role of public programs in health care including Medicare for All or Medicaid buy-in programs that could have significant implications for Medicaid.

  • Medicaid Work Requirements in Arkansas: Experience and Perspectives of Enrollees

    Issue Brief

    This brief presents perspectives of enrollees and safety net providers about Arkansas' new Section 1115 Medicaid waiver work and reporting requirements based on focus groups and interviews. The discussions examine enrollees’ awareness of the new requirements and ability to set up online accounts for monthly reporting; the effect of the new requirements on enrollees’ work and common barriers to work; enrollees’ experience with monthly reporting; impacts on particular populations, such as those with disabilities or who are homeless; and the anticipated effects of coverage losses resulting from the new requirements.