The Utah legislature significantly changed and limited the Medicaid coverage expansion that was adopted by the voters through a ballot initiative in November 2018. This issue brief explains new provisions in Utah’s recently amended Section 1115 Medicaid waiver and the forthcoming amendments that the state is expected to submit to CMS, including a request for enhanced ACA federal matching funds for a partial capped expansion.
Featured Medicaid’s Future Resources
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.
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Related Medicaid’s Future Resources
- Implications of a Medicaid Work Requirement: National Estimates of Potential Coverage Losses
- Implications of the ACA Medicaid Expansion: A Look at the Data and Evidence
- Implications of Work Requirements in Medicaid: What Does the Data Say?
- Medicaid and Work Requirements: New Guidance, State Waiver Details and Key Issues
- Medicaid’s Role in Addressing the Opioid Epidemic
- The Opioid Epidemic and Medicaid’s Role in Facilitating Access to Treatment
- Governors’ Proposed Budgets for FY 2019: Focus on Medicaid and Other Health Priorities
- Snapshots of Recent State Initiatives in Medicaid Prescription Drug Cost Control
- How Might Medicaid Adults with Disabilities Be Affected By Work Requirements in Section 1115 Waiver Programs?
- How Might Older Nonelderly Medicaid Adults with Disabilities Be Affected By Work Requirements in Section 1115 Waivers?
- Medicaid Enrollees and Work Requirements: Lessons From the TANF Experience
- Understanding the Intersection of Medicaid and Work
- Status of State Action on the Medicaid Expansion Decision
- The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review
- Implications of the ACA Medicaid Expansion: A Look at the Data and Evidence
- Section 1115 Medicaid Demonstration Waivers: The Current Landscape of Approved and Pending Waivers
- Digging Into the Data: What Can We Learn from the State Evaluation of Healthy Indiana (HIP 2.0) Premiums
- Implications of Emerging Waivers on Streamlined Medicaid Enrollment and Renewal Processes
- Approved Changes to Medicaid in Kentucky
- A Guide to the Lawsuit Challenging CMS’s Approval of the Kentucky HEALTH Medicaid Waiver
- Medicaid Retroactive Coverage Waivers: Implications for Beneficiaries, Providers, and States
- Data Note: 10 Charts About Public Opinion on Medicaid
- Poll: Public Mixed on Whether Medicaid Work Requirements Are More to Cut Spending or to Lift People Up; Most Do Not Support Lifetime Limits on Benefits
- Data Note: Data Do Not Support Relationship Between Medicaid Expansion Status and Home and Community-Based Services Waiver Waiting Lists
This issue brief summarizes the DC federal district court’s June 29, 2018 decision in Stewart v. Azar, the lawsuit brought by Medicaid enrollees challenging the HHS Secretary’s approval of the Kentucky HEALTH Section 1115 waiver program, which includes a work requirement, premiums, coverage lockouts, and other provisions that the state estimated would lead 95,000 people to lose coverage.
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This Medicaid waiver tracker page aggregates tracking information on pending and approved Section 1115 Medicaid waivers. It includes resources such as an overview map and figure, detailed waiver topic tables, and explanatory briefs.
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. Medicaid is administered by states within broad federal rules and jointly funded by states and the federal government. This brief examines the following three key Medicaid financing questions: How does Medicaid financing work now?; How much does Medicaid cost and how are funds spent?; What is the role of Medicaid in federal and state budgets?
“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.
Medicaid, the provider of health insurance coverage for about one in five Americans and the largest payer for long-term care services in the community and nursing homes, continues to be a key part of health policy debates at the federal and state level. Important Medicaid issues to watch in 2019 include Medicaid expansion developments amid ongoing litigation about the ACA’s constitutionality as well as Medicaid demonstration waiver activities, including those focused on work requirements and other eligibility restrictions. States are also likely to continue to pursue initiatives to address the opioid crisis, and the recent passage of bi-partisan legislation with new tools and financing could bolster these efforts. Primary areas of federal policy to watch in 2019 with implications for Medicaid include the expiration of temporary funding for Puerto Rico and the US Virgin Islands in the absence of legislative action as well as potential regulatory changes to public charge policies that would likely lead to Medicaid enrollment declines among immigrant families. Finally, reforms in benefits, payment and delivery systems continue to evolve as states and the federal government focus on managed care, social determinants of health, prescription drugs, and community based long-term care. While beyond the scope of this brief, Congress and states could also consider broader health reform that could expand the role of public programs in health care including Medicare for All or Medicaid buy-in programs that could have significant implications for Medicaid.
KFF Health Tracking Poll – November 2018: Priorities for New Congress and the Future of the ACA and Medicaid Expansion
Fielded a week after the 2018 midterm elections, this poll examines the public’s priorities for the next Congress, measures favorability for ACA provisions including Medicaid expansion, and takes a look at knowledge of the current open enrollment period among adults ages 18-64 who purchase their own insurance or are currently uninsured. With the impending Texas v. United States lawsuit, in addition to several Trump administration policy actions aimed at different aspects of the U.S. health care system, this KFF survey also examines the public’s position on pre-existing conditions protections, prescription drug advertisements, and employer exemptions from covering birth control.
Bipartisan Majorities Support Trump Administration’s Push to Get Drug Prices in Advertisements, Even after Hearing Counter-Arguments
Only 1 in 4 Potential Marketplace Customers Know When ACA Open Enrollment Ends; 1 in 5 Say They Would Buy a Short-Term Plan A large majority of the public backs the Trump Administration’s initiative to require prescription drug advertisements to include information about prices, but fewer support other administrative actions…
Public More Likely To Trust Democratic Party To Do A Better Job Dealing With Most Health Care Issues
A new analysis featuring data from the KFF Election Tracking Poll released in October 2018 finds that the public trusts the Democratic Party more than the Republican Party when it comes to dealing with health care issues, such as increasing women’s access to reproductive services, maintaining Medicaid expansion, and maintaining protections for pre-existing conditions.
In an expansive look at the 2018 midterm elections, this month’s KFF Health Tracking Poll includes an in-depth examination of the role health care may be playing in midterm elections nationally, as well as in Florida and Nevada, two bellwether states in which candidates from both parties are talking about health care issues. Health care remains a top priority for Democrats and independents, but ranks lower for Republicans, behind immigration and the economy and jobs. However, when it comes to specific health care issues, lowering health care costs and maintaining protections for pre-existing conditions have bipartisan support. In addition to exploring the role of health care issues in the election, the KFF Health Tracking Poll also finds large shares of voters say candidate characteristics, President Trump, and party control over Congress will be major factors in their voting decisions.