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What Could a Medicaid Per Capita Cap Mean for Low-Income People on Medicare?

Policymakers are currently considering proposals that would fundamentally change the structure and financing of Medicaid, and potentially affect 11 million people on Medicare. This brief discusses the potential implications of Medicaid per capita cap or block grant proposals for the 11 million low-income seniors and people with disabilities on Medicare. It also describes how the per capita cap model proposed in the American Health Care Act could potentially affect low-income people on Medicare who receive assistance from Medicaid.

Data Note: Three Findings about Access to Care and Health Outcomes in Medicaid

The Medicaid program covers 74 million low-income Americans, including many of the poorest and sickest people in our society. Among those served are pregnant women and children, parents and other adults, poor seniors, and people with disabilities. Given Medicaid’s major coverage role and the complex needs of the populations it covers, data and evidence on access to care and health outcomes in Medicaid are of key interest. Such an assessment is also important to ensure that debate about the effectiveness of the Medicaid program is grounded in facts and analysis. This Data Note discusses what the research shows.

Medicaid Pocket Primer

Medicaid, the nation’s public health insurance program for people with low income, covers 1 in 5 Americans, including many with complex and costly health care needs. Medicaid is also the primary source of long-term care coverage in the U.S. State and federal Medicaid dollars provide significant financing for our health care system and finance over 16% of personal health spending. This primer outlines fundamentals of the Medicaid program.

Improving the Affordability of Coverage through the Basic Health Program in Minnesota and New York

To date, Minnesota and New York are the only states to have adopted a Basic Health Program (BHP), an option in the Affordable Care Act (ACA) that permits state-administered coverage in lieu of marketplace coverage for those with incomes below 200% of the federal poverty level (FPL) who would otherwise qualify for marketplace subsidies. BHP covers adults with incomes between 138-200% of FPL and lawfully present non-citizens with incomes below 138% FPL whose immigration status makes them ineligible for Medicaid. This brief reviews Minnesota’s and New York’s approaches to BHP and assesses BHP’s impact on consumers, marketplaces, and state costs. Although there is uncertainty around the future of the ACA (including BHP) following the 2016 election, BHP implementation offers important lessons for consideration in future reforms about structuring coverage programs for low-income uninsured consumers.

Modifying Traditional Medicare’s Benefit Design Could Reduce Federal Spending But With Cost Tradeoffs Between Beneficiaries and The Federal Government

Revamping traditional Medicare’s benefit design and restricting “first-dollar” supplemental coverage could reduce federal spending, simplify cost sharing, protect against high medical costs, decrease out-of-pocket spending for many beneficiaries, and provide more help to those with low incomes — but would be unlikely to achieve all of these goals simultaneously.

Modifying Medicare’s Benefit Design: What’s the Impact on Beneficiaries and Spending?

This report examines an approach to reforming Medicare that has been a focus of Congressional hearings and featured in several broader debt reduction and entitlement reform proposals, and was included in the June 2016 House Republican health plan. The analysis models four different options for modifying Medicare’s benefit design, all of which include a single deductible, modified cost-sharing requirements, a new cost-sharing limit, and a prohibition on first-dollar Medigap coverage. The analysis models the expected effects on out-of-pocket spending by beneficiaries in traditional Medicare, and assesses how each option is expected to affect spending by the federal government, state Medicaid programs, employers, and other payers, assuming full implementation in 2018.

ACA Coverage Expansions and Low-Income Workers

This brief highlights low-income workers and the impact of ACA coverage expansions on this population. Low-income workers may not have access to jobs that provide full-time, full-year employment or jobs with comprehensive benefit packages, including health insurance. Medicaid plays an important role in providing health coverage for low-income workers, and coverage expansions implemented under the ACA have produced substantial coverage gains for low-income workers and a corresponding reduction in the uninsured. However, low-income workers in non-expansion states with incomes too high for Medicaid but too low for subsidies in the Marketplace do not have an affordable coverage option and will likely remain uninsured.

ACA Coverage and the Changing Labor Market: Voices from the Field

This brief highlights voices from adult focus group participants with low and moderate incomes who gained Medicaid or Marketplace coverage following implementation of the ACA. It focuses on work, including work status, the new labor market, job benefits, and the role of ACA coverage for those with non-traditional jobs.

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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.