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Potential Changes to Medicaid Long-Term Care Spousal Impoverishment Rules: States’ Plans and Implications for Community Integration

To financially qualify for Medicaid long-term services and supports (LTSS), an individual must have a low income and limited assets. In response to concerns that these rules could leave a spouse without adequate means of support when a married individual needs LTSS, Congress created the spousal impoverishment rules in 1988. Originally, these rules required states to protect a portion of a married couple’s income and assets to provide for the “community spouse’s” living expenses when determining nursing home financial eligibility, but gave states the option to apply the rules to home and community-based services (HCBS) waivers.
Section 2404 of the Affordable Care Act (ACA), changed the spousal impoverishment rules to treat Medicaid HCBS and institutional care equally from January 2014 through December 2018. Congress subsequently extended Section 2404 through March 2019. This issue brief answers key questions about the spousal impoverishment rules, presents 50-state data from a 2018 Kaiser Family Foundation survey about state policies and future plans in this area, and considers the implications if Congress does not further extend Section 2404.

“Partial” Medicaid Expansions Could Limit States’ Spending But Cover Fewer People at a Higher Federal Cost Compared to Traditional ACA Expansions

If states were able to receive enhanced Affordable Care Act matching funds for “partial” expansions of Medicaid, fewer people would get health coverage and the federal government would spend more, compared to a traditional expansion under the law, KFF explains in a new brief. The explainer describes how a partial…

“Partial Medicaid Expansion” with ACA Enhanced Matching Funds: Implications for Financing and Coverage

The Affordable Care Act (ACA) provides enhanced federal matching funds to states that expand Medicaid to nonelderly adults up to 138% of the federal poverty level (FPL, $17,236/year for an individual in 2019). The ACA enhanced match (93% in 2019, and 90% in 2020 and thereafter) is substantially higher than states’ traditional Medicaid matching rate. A few states have sought Section 1115 demonstration waiver authority from the Centers for Medicare and Medicaid Services (CMS) to receive the substantially higher ACA enhanced match while limiting coverage to individuals at 100% FPL, instead of covering the full 138% FPL ACA group. To date, CMS has allowed states to receive the ACA enhanced Medicaid matching funds only if the entire expansion group is covered. CMS has not approved waiver requests seeking enhanced ACA matching funds for a partial coverage expansion in Arkansas or Massachusetts, while a request is pending in Utah. This brief explores the current rules for partial expansion and explains some of the potential implications for financing and coverage if CMS approves waivers to allow for partial expansion with enhanced matching funds.

The U.S. Congress and Global Health: A Primer

This primer provides an overview of congressional engagement in global health. It examines the structure of Congress and its role and key activities in global health. It then illustrates these by examining two global health examples: the creation and evolution of PEPFAR and the 2014/2015 Ebola outbreak in West Africa.

An Overview of Medicare

This issue brief provides an overview of Medicare, the health insurance program for people ages 65 and over and younger people with long-term disabilities. The brief review the characteristics of people on Medicare, what Medicare covers, benefit gaps and supplemental coverage, beneficiaries’ out-of-pocket health care spending, program spending and financing, payment and delivery system reform, and issues for the future of Medicare.

The U.S. & The Global Fund to Fight AIDS, Tuberculosis and Malaria

This fact sheet examines the key role played by the United States in the Global Fund, an independent, multilateral financing entity designed to raise significant new resources to combat HIV/AIDS, tuberculosis (TB), and malaria in low- and middle- income countries.

The U.S. Government Engagement in Global Health: A Primer

This primer provides basic information about global health and U.S. government programs that address global health. The first several sections provide an overview of the field of global health and describe current global health issues. The subsequent sections describe U.S. government support for global health, from the programs the government supports, to the organization of the U.S. response, the budgets and financing of U.S. global health programs, and the U.S. government’s relationship with multilateral institutions and international partners.

The U.S. & Gavi, the Vaccine Alliance

This fact sheet examines the Gavi, the Vaccine Alliance (also known as Gavi), an independent, public-private partnership and multilateral funding mechanism that aims to increase access to immunization in poor countries, and explores the role the U.S. government plays in supporting the partnership.

Breaking Down the U.S. Global Health Budget by Program Area

The U.S. government is the largest donor to global health in the world. This fact sheet breaks down the U.S. global health budget by program area: HIV/PEPFAR; tuberculosis (TB); malaria/the President’s Malaria Initiative (PMI); the Global Fund to Fight AIDS, Tuberculosis, and Malaria; maternal & child health (MCH); nutrition; family planning & reproductive health (FP/RH); global health security; and neglected tropical diseases (NTDs).

The Henry J. Kaiser Family Foundation Headquarters: 2400 Sand Hill Road, Menlo Park, CA 94025 | Phone 650-854-9400
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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.