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Implications of the ACA Medicaid Expansion: A Look at the Data and Evidence

More than four years after the implementation of the Medicaid expansion included in the Affordable Care Act, debate and controversy around the implications of the expansion continue. Despite a large body of research that shows that the Medicaid expansion results in gains in coverage, improvements in access and financial security, and economic benefits for states and providers, some argue that the Medicaid expansion has broadened the program beyond its original intent diverting spending from the “truly needy”, offers poor quality and limited access to providers, and has increased state costs. New proposals allow states to implement policies never approved before including conditioning Medicaid eligibility on work or community engagement. New complex requirements run counter to the post-ACA movement of Medicaid integration with other health programs and streamlined enrollment processes. This brief examines evidence of the effects of the Medicaid expansion and some changes being implemented through waivers. Many of the findings on the effects of expansion cited in this brief are drawn from the 202 studies included in our comprehensive literature review that includes additional citations on coverage, access, and economic effects of the Medicaid expansion.

Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender (LGBT) Individuals in the U.S.

Lesbian, gay, bisexual, and transgender (LGBT) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes. These challenges can include stigma, discrimination, violence, and rejection by families and communities, as well as other barriers, such as inequality in the workplace and health insurance sectors, the provision of substandard care, and outright denial of care because of an individual’s sexual orientation or gender identity. This issue brief examines population characteristics of the LGBT community and the impacts of the Affordable Care Act (ACA), Supreme Court rulings and other policy changes related to same-sex marriage that can insurance coverage and access to health care services, and recent actions by the Trump Administration.

Where Are States Today? Medicaid and CHIP Eligibility Levels for Children, Pregnant Women, and Adults

This fact sheet provides an overview of eligibility levels for children, pregnant women, parents, and other non-disabled adults in Medicaid and CHIP. The data are based on eligibility levels reported by states as of January 2018. The findings highlight Medicaid’s continued role as a primary source of coverage for children and pregnant women and its expanded role for low-income adults under the Affordable Care Act (ACA).

The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review

This issue brief summarizes findings from 202 studies of the impact of state Medicaid expansions under the ACA published between January 2014 (when the coverage provisions of the ACA went into effect) and February 2018. It includes studies, analyses, and reports published by government, research, and policy organizations using data from 2014 or later. This body of research suggests that the expansion presents an opportunity for gains in coverage, improvements in access and financial security, and economic benefits for states and providers.

Data Note: Data Do Not Support Relationship Between Medicaid Expansion Status and Home and Community-Based Services Waiver Waiting Lists

Some have said that state choices about whether to adopt the ACA’s Medicaid expansion come at the expense of providing Medicaid home and community-based services (HCBS). Since 2002, the Kaiser Family Foundation has surveyed states about their HCBS waiver waiting lists. All states offer at least one HCBS waiver for seniors and people with disabilities today. States choose how many people to serve under these waivers, and their ability to limit enrollment can result in waiting lists when the number of people seeking services exceeds the number of waiver slots. This analysis examines the most recent data available, including HCBS waiver waiting list data for 2015 and 2016. The data do not support a relationship between a state’s Medicaid expansion status, which is primarily financed with federal funds, and changes in its HCBS waiver waiting list.

Abortion Coverage in the Premium Relief Act of 2017 (HR 4666)

This issue brief reviews current federal and state policies on private insurance coverage of abortion services, and how the Premium Relief Act of 2017 would affect abortion coverage for women enrolled in the individual market and some small group plans.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.