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Challenges in the U.S. Territories: COVID-19 and the Medicaid Financing Cliff

More than a year into the public health emergency, the COVID-19 pandemic continues to impact the lives of Americans including those living in the U.S. territories. Differences in Medicaid financing, including a statutory cap and match rate, have contributed to broader fiscal and health systems challenges for the territories. While additional federal funds have been provided over the statutory caps, these funds are set to expire at the end of September 2021. Without additional Congressional action, the territories will lose the vast majority of Medicaid financing which could result in reductions in coverage, services, and provider rates which could negatively impact the territories as they deal with the long-term health and economic consequences of the pandemic. This brief looks at how the pandemic is affecting the territories as well as issues related to the upcoming Medicaid fiscal cliff.

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Medicaid Financing: The Basics

Medicaid represents $1 out of every $6 spent on health care in the US and is the major source of financing for states to provide coverage to meet the health and long-term care needs of their low-income residents. This brief examines the following key Medicaid financing questions: How does Medicaid financing work?; How much does Medicaid cost and how are funds spent?; What is the role of Medicaid in federal and state budgets?; What are the implications of the pandemic on Medicaid and state budgets?

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Medicaid Provisions in the American Rescue Plan Act

The American Rescue Plan Act, the COVID-19 relief package that became law on March 11, 2021, contains a number of provisions designed to increase coverage, expand benefits, and adjust federal financing for state Medicaid programs. These provisions are briefly described below and summarized in Table 1. Separate briefs summarize provisions in the new law relating to the Marketplaces and public health.

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New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending

The American Rescue Plan Act of 2021 encourages non-expansion states to take up the expansion by providing an additional temporary fiscal incentive for states to newly implement the ACA Medicaid expansion. This brief provides illustrative estimates of the net fiscal benefit to states from these incentives relative to state costs under the expansion.

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Medicaid Spending and Enrollment Trends Amid the COVID-19 Pandemic – Updated for FY 2021 & Looking Ahead to FY 2022

Even as the COVID-19 vaccine roll-out is accelerating across the country, the public health and economic effects of the pandemic continue to put pressure on Medicaid spending and enrollment. In mid-February 2021, the Kaiser Family Foundation (KFF) and Health Management Associates (HMA) fielded a two-part rapid, mini-survey of Medicaid directors in all 50 states and the District of Columbia as a follow-up to the annual Medicaid Budget Survey conducted last summer. This brief provides insights into the current status of Medicaid enrollment and spending trends in FY 2021 and state projections for FY 2022.

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State Variation in Medicaid LTSS Policy Choices and Implications for Upcoming Policy Debates

This brief takes a closer look at multiple measures beyond waiver waiting lists to evaluate state choices about optional Medicaid eligibility pathways, spending, and services for seniors and people with disabilities as of 2018. The analysis draws on several KFF resources, including 50-state surveys of Medicaid financial eligibility pathways for seniors and people with disabilities, HCBS waiver programs, and state plan benefits offered, as well as state Medicaid LTSS expenditures reported by Mathematica.

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Two New Analyses: House COVID-19 Relief Plan Would Temporarily Lower Marketplace Premiums for Millions and More than Offset Short-Term State Costs to Expand Their Medicaid Programs

The House COVID-19 relief proposal would temporarily lower what millions of Marketplace enrollees and uninsured potential enrollees would pay toward premiums and would provide states that have not expanded their Medicaid programs a financial boost that would more than offset their costs initially, two new KFF analyses find. The analyses…

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As Coronavirus Cases Surged This Fall, Admissions to Hospitals for Reasons Other Than COVID-19 Fell Markedly, Especially in the Midwest and West

Admissions to hospitals for reasons other than COVID-19 fell markedly again in November as cases of infections with the novel coronavirus began to surge anew, suggesting that more people were delaying care due to the worsening pandemic, according to an updated analysis by Epic Health Research Network (EHRN) and KFF.…

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Trends in Overall and Non-COVID-19 Hospital Admissions

This brief shows trends in hospital admissions during the coronavirus pandemic. Admissions to hospitals for reasons other than COVID-19 fell markedly again in November 2020 as cases of infections with the novel coronavirus began to surge anew, suggesting that more people were delaying care due to the worsening pandemic.

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The U.S. Ending the HIV Epidemic (EHE) Initiative: What You Need to Know

This explainer provides an overview of the federal “Ending the HIV Epidemic” initiative and explores issues that might mitigate or facilitate its success.

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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.