Implementing Coverage and Payment Initiatives: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2016 and 2017

Introduction

Medicaid has become one of the nation’s most important health care programs, now providing health insurance coverage to more than one in five Americans, and accounting for over one-sixth of all U.S. health care expenditures.¹ The Medicaid program continues to change, as policy makers in each state seek to improve their program, responding to changes in the economy, the broader health system, state budgets and policy priorities, and in recent years, to requirements and opportunities in the Affordable Care Act (ACA) as well as new guidance and regulations. In many ways, state Medicaid programs are national leaders in delivery and payment system initiatives designed to improve health care and outcomes, and to control health care spending.

This report examines the reforms, policy changes and initiatives that occurred in FY 2016 and those adopted for implementation for FY 2017 (which began for most states on July 1, 2016²). The findings in this report are drawn from the 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 (KCMU) and Health Management Associates (HMA), in collaboration with the National Association of Medicaid Directors (NAMD). This was the sixteenth annual survey, which has been conducted at the beginning of each state fiscal year from FY 2002 through FY 2017.³ (Copies of previous reports are archived here.)

The KCMU/HMA Medicaid survey on which this report is based was conducted from June through August 2016. The survey was sent to each state Medicaid director in June 2016. Directors and their staff provided data for this report in their written survey response and through a follow-up telephone interview. All 50 states and DC completed surveys and participated in telephone interview discussions between June and August 2016. The survey instrument is included as an appendix of this report.

The survey collects some data about Medicaid policies in place during a base year, but focuses on changes from year-to-year. For FY 2017, the survey includes policy changes implemented at the beginning of the year, or for which a definite decision has been made to implement during the fiscal year; it does not include policy changes under consideration but for which a definite decision on implementation has not been made. Medicaid policy makers know that policies adopted for the upcoming year are sometimes delayed or not implemented for reasons related to legal, fiscal, administrative, systems or political considerations, or due to delays in approval from CMS. The District of Columbia is counted as a state for the purposes of this report; the counts of state policies or policy actions that are interspersed throughout this report include survey responses from the 51 “states” (including DC). Key findings of this survey, along with state-by-state tables providing more detailed information, are described in the following sections of this report:

• Eligibility, Enrollment, Premiums, and Copayments
• Managed Care Initiatives
• Emerging Delivery System and Payment Reforms
• Long-Term Services and Supports Reforms
• Provider Rates and Taxes
• Benefits and Pharmacy
• Administrative Challenges, Priorities, and Conclusion