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Medicaid Spending, Enrollment and Policy Trends: A View from the States

At 9:30 a.m. ET on Friday, Oct. 18, KFF will release its 19th annual 50-state Medicaid budget survey for state fiscal years 2019 and 2020. KFF and the National Association of Medicaid Directors (NAMD) will hold a joint briefing to discuss trends in enrollment and spending and highlight key Medicaid policy developments.

Recent Medicaid/CHIP Enrollment Declines and Barriers to Maintaining Coverage

Recently there have been declines in Medicaid and CHIP enrollment, reversing a previous trend of increases following implementation of the ACA. Experiences in some states suggest that renewal process requirements and growing use of periodic eligibility checks may be contributing to disenrollment among people who are still eligible for coverage as well as increased churn in coverage. This brief reviews current rules and state processes related to renewal and periodic eligibility reviews and discusses potential process issues that may be contributing to Medicaid and CHIP enrollment declines.

Financial Performance of Medicare Advantage, Individual, and Group Health Insurance Markets

Three key private health insurance markets — Medicare Advantage, the individual market and the fully-insured group market — appear to be financially healthy and attractive to insurers. The private Medicare Advantage market generates significantly larger gross margins per person than the individual market or fully-insured market. The future of these markets has become a focus for policymakers amid the debate over Medicare for All.

How Connecting Justice-Involved Individuals to Medicaid Can Help Address the Opioid Epidemic

This issue brief identifies key lessons learned from how four states (Missouri, Ohio, New Mexico, Rhode Island) are connecting people leaving the criminal justice system to Medicaid coverage and services, with a focus on medication-assisted treatment (MAT) and supports for people with opioid use disorder. It builds on previous briefs that assessed state efforts to connect people involved in the justice system to Medicaid coverage. It is based on interviews conducted in late 2018 and early 2019 with state Medicaid, behavioral health, and corrections officials in the four states and in Bernalillo County, New Mexico, as well as interviews with managed care organizations, providers, and advocates in those states and published information on the states’ experiences.

A Dozen Facts About Medicare Advantage in 2019

Medicare Advantage enrollment has grown rapidly over the past decade, and Medicare Advantage plans have taken on a larger role in the Medicare program. More than 22 million Medicare beneficiaries (34%) are enrolled in Medicare Advantage plans in 2019. This data note provides updated information about Medicare Advantage enrollment trends, premiums, and out-of-pocket limits. It also includes analyses of Medicare Advantage plans’ extra benefits and prior authorization requirements.

What Percent of New Medicare Beneficiaries Are Enrolling in Medicare Advantage?

The analysis examines enrollment in Medicare Advantage plans during beneficiaries’ first year on Medicare and finds that less than one-third or 29% enrolled in these private health plans, including HMOs or PPOs. The majority of people new to Medicare are choosing traditional Medicare in the year they first go on Medicare. The study looks at how these findings vary across age, Medicaid status, states, and counties.

Medicare Advantage

This fact sheet includes the latest information and data about the Medicare Advantage program, including enrollment, plan information, spending and financing for the program, and payment and program changes made by the Affordable Care Act as well as other laws.