Filling the need for trusted information on national health issues…

In 2017, President Donald Trump and Republicans in Congress unsuccessfully sought to repeal and replace the Affordable Care Act and switch Medicaid to a system of per capita cap financing. They may pursue such policy goals again this year. At the same time, the Trump administration has signaled a willingness to allow states to use Section 1115 waiver authority to reshape Medicaid, with several states seeking waiver provisions not previously approved by any administration, including work requirements, drug screening and testing, eligibility time limits, and premiums with disenrollment for non-payment for traditional Medicaid populations. And continuing efforts to combat the opioid epidemic are likely to focus attention on Medicaid’s role in the fight.
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Digging Into the Data: What Can We Learn from the State Evaluation of Healthy Indiana (HIP 2.0) Premiums

Indiana initially implemented the ACA’s Medicaid expansion through a Section 1115 waiver in February 2015. Indiana’s waiver included important changes from federal law regarding enrollment and premiums. The initial waiver expired, and Indiana received approval for a waiver extension in February, 2018 which continues most components of HIP 2.0 and adds some new provisions related to enrollment and premiums. This brief looks at available data from the state’s evaluation of premiums prepared by The Lewin Group (as well as other reporting to CMS) to highlight what is known about the impact of these policies to date. We review these data to identify potential implications for changes in the recent Indiana renewal and for other states considering similar provisions.

Medicaid Managed Care Plans and Access to Care: Results from the Kaiser Family Foundation 2017 Survey of Medicaid Managed Care Plans

Managed care organizations (MCOs) cover nearly two-thirds of all Medicaid beneficiaries nationwide, making managed care the nation’s dominant delivery system for Medicaid enrollees. As the entities responsible for providing comprehensive Medicaid benefits to enrollees by contracting with providers, managed care plans play a critical role in shaping access to care for Medicaid enrollees. Many plan actions are dictated by state policy or contracting requirements; however, plans also have some flexibility to design payment and delivery systems and structure enrollees’ experiences using their coverage. To understand how Medicaid managed care plans approach access to care and the challenges they face in ensuring such access, the Kaiser Family Foundation conducted a survey of plans in 2017.

Medicaid Waiver Tracker: Which States Have Approved and Pending Section 1115 Medicaid Waivers?

This resource tracks states with approved Section 1115 Medicaid waivers and pending waivers (which include new waiver applications, waiver amendments, and renewals). View approved and pending waivers according to waiver category. Related waiver resources are available by topic at the bottom of the page, as are additional details on each approved and pending waiver.

Kaiser Health Tracking Poll – February 2018: Health Care and the 2018 Midterms, Attitudes Towards Proposed Changes to Medicaid

At a time when some states are considering changes to their Medicaid programs, the February Kaiser Health Tracking Poll measures Americans’ attitudes toward Medicaid and examines views on work requirements and lifetime limits on benefits. The poll also continues to find the public leaning favorably towards the ACA, with this month marking the highest level of favorability since 2010. When asked to say in their own words what health care issue they most want 2018 midterm candidates to discuss, voters mention health care costs as their top concern.

Implications of Emerging Waivers on Streamlined Medicaid Enrollment and Renewal Processes

The Affordable Care Act (ACA) significantly modernized and streamlined Medicaid enrollment and renewal processes across all states. Through major investments of time, money, and staff, most states have implemented modernized systems that transformed lengthy, paperwork driven enrollment and renewal procedures to a simplified, technology-driven experience that minimizes burdens on individuals and states. Recently approved and proposed waivers and other proposed policies include new eligibility and enrollment requirements and restrictions that run counter to the ACA’s streamlined processes (Figure 1). This fact sheet provides an overview of how enrollment and renewal processes changed under the ACA and the implications of emerging waivers and other proposed changes on streamlined enrollment and renewal.

Medicaid’s Role for Children with Special Health Care Needs: A Look at Eligibility, Services, and Spending

This issue brief describes the role that Medicaid plays for children with special health care needs. It explains common eligibility pathways, covered services, and program spending for these children. The Appendix includes 50-state data on the number of children with special health care needs covered by Medicaid/CHIP. A companion brief compares key characteristics of Medicaid/CHIP children with special health care needs to those covered by private insurance.

How Do Medicaid/CHIP Children with Special Health Care Needs Differ from Those with Private Insurance?

This issue brief compares the demographics, health status, access to care, and coverage affordability of Medicaid/CHIP children with special health care needs to those with private insurance and those who are uninsured. Medicaid plays a key role for children with special health care needs by making coverage affordable and covering services that private coverage typically does not. Consequently, legislative proposals that would cap and reduce federal Medicaid funding may pose a particular risk to children with special health care needs and their providers. While Congress did not pass such legislation in 2017, these proposals may resurface in 2018, and the Trump Administration’s FY 2019 proposed budget continues to advance these proposals. A companion brief describes Medicaid’s role for children with special health care needs.

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.

The Henry J. Kaiser Family Foundation Headquarters: 2400 Sand Hill Road, Menlo Park, CA 94025 | Phone 650-854-9400
Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270 | Email Alerts: | |

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