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New Brief Examines Potential Changes to Medicaid Long-Term Care “Spousal Impoverishment” Rules

A new brief from KFF (the Kaiser Family Foundation) examines potential changes to “spousal impoverishment” rules in Medicaid that allow married couples to protect a portion of their income and assets should one spouse seek Medicaid coverage for long-term care. A provision of the Affordable Care Act that requires state Medicaid…

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States Focus on Quality and Outcomes Amid Waiver Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019

This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. Report findings are drawn from the annual budget survey of Medicaid officials in all 50 states and the District of Columbia. This report examines the reforms, policy changes, and initiatives that occurred in FY 2018 and those adopted for implementation for FY 2019 (which began for most states on July 1, 2018). Key areas covered include changes in eligibility, managed care and delivery system reforms, long-term services and supports, provider payment rates and taxes, covered benefits, and pharmacy and opioid strategies.

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50-State Survey Finds Flat Medicaid Enrollment Tied to a Stronger Economy and New Eligibility Systems

For the first time in a decade, states are reporting no overall growth in Medicaid enrollment last year and expecting minimal growth this year amid a stronger economy, a new Kaiser Family Foundation survey finds. The 18th annual 50-state survey of Medicaid directors reveals that enrollment was flat in state…

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How Might Older Nonelderly Medicaid Adults with Disabilities Be Affected By Work Requirements in Section 1115 Waivers?

Most of the states with approved or pending Section 1115 waivers that condition Medicaid eligibility on work would apply those requirements to all or most nonelderly adults (ages 19-64) who are not receiving Supplemental Security Income (SSI) cash assistance, including older nonelderly adults (ages 50-64). Older nonelderly adults may be limited in their ability to satisfy a work requirement due to barriers resulting from age and/or disability. Previous analysis shows that many nonelderly Medicaid adults (ages 19-64) have functional limitations that may interfere with their ability to work but do not rise to the stringent SSI level of disability, making them potentially subject to work requirements. Older nonelderly adults are over twice as likely to have a disability than younger adults (17% vs. 7%). Furthermore, older nonelderly adults account for nearly half (45%) of all nonelderly Medicaid adults with a disability but not SSI who could be affected by a work requirement. This analysis examines the implications of work requirements for Medicaid adults ages 50 to 64 (referred to as “older nonelderly Medicaid adults”) and provides national and state level estimates of their disability, SSI, and work status using data from the 2016 American Community Survey (ACS).

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Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2018: Findings from a 50-State Survey

This 16th annual 50-state survey provides data on Medicaid and the Children’s Health Insurance Program (CHIP) eligibility, enrollment, renewal and cost sharing policies as of January 2018. It takes stock of how the programs have evolved as the fifth year of implementation of the Affordable Care Act (ACA) begins, discusses policy changes made during 2017, and looks ahead to issues that may affect state policies moving forward. It is based on a survey of state Medicaid and CHIP officials conducted by the Kaiser Family Foundation and the Georgetown University Center for Children and Families. State data are available in Appendix Tables 1-20.

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Approved Changes in Indiana’s Section 1115 Medicaid Waiver Extension

On February 1, 2018, the Centers for Medicare and Medicaid Services (CMS) approved an amended extension of Indiana’s Healthy Indiana Program 2.0 (HIP 2.0) Section 1115 demonstration waiver. Indiana’s waiver initially implemented the ACA’s Medicaid expansion from February, 2015 through January, 2018 by modifying Indiana’s pre-ACA limited coverage expansion waiver (HIP 1.0). Unlike other states that implemented the ACA’s Medicaid expansion through a waiver, Indiana’s demonstration also changes the terms of coverage for non-expansion adults (low-income parents and those eligible for Transitional Medical Assistance, TMA). The February, 2018 extension continues most components of HIP 2.0 and adds some new provisions.

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A Guide to the Lawsuit Challenging CMS’s Approval of the Kentucky HEALTH Medicaid Waiver

On January 11, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a State Medicaid Director letter announcing a new policy that, for the 1st time, allows states to condition Medicaid on participation in a work or “community engagement” program. The next day, CMS approved a new Medicaid waiver in Kentucky. The waiver includes a program called Kentucky HEALTH, which encompasses a work requirement as well as coverage lockouts of up to 6 months for failure to pay monthly premiums (up to 4% of income), timely renew eligibility, or timely report a change in circumstances, among other provisions. Kentucky HEALTH applies to most nonelderly adults, including low-income parents and expansion adults. The state plans to implement Kentucky HEALTH by July, 2018. On January 24, 2018, 15 Kentucky Medicaid enrollees filed a lawsuit in the U.S. District Court for the District of Columbia challenging CMS’s authority to issue the work requirement policy and approve the Kentucky waiver. This issue brief answers 5 key questions about the case.

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Summary of the 2018 CHIP Funding Extension

On January 22, 2018, Congress passed a six-year extension of CHIP funding as part of a broader continuing resolution to fund the federal government. Federal funding for CHIP had expired on September 30, 2017. Without additional funding available, states operated their CHIP programs using remaining funds from previous years. However, some states came close to exhausting funding, leading them to make contingency plans to reduce coverage and notify families of potential coverage reductions. In late December 2017, Congress provided some short-term funding for early 2018, but some states still expected to exhaust funds by March 2018. The six-year funding extension provides stable funding for states to continue their CHIP coverage. This fact sheet provides a summary of key provisions of the CHIP funding extension.

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Approved Changes to Medicaid in Kentucky

On January 12, 2018, the Centers for Medicare and Medicaid Services (CMS) approved a Section 1115 demonstration waiver in Kentucky, entitled “Kentucky Helping to Engage and Achieve Long Term Health” or KY HEALTH. On the same day that CMS approved Kentucky’s waiver, Governor Bevin issued an executive order directing the state to terminate the Medicaid expansion if a court decides that one or more of the waiver provisions are illegal and cannot be implemented. This fact sheet summarizes key provisions of Kentucky’s approved waiver.

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