Medicaid’s Future

Most Florida Voters Favor Expanding Medicaid in their State, As Do Voters across All Non-Expansion States In an expansive look at the role issues and politics may play in the 2018 midterm elections, the latest KFF Health Tracking Poll continues to find health care as the top issue for voters,…

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.

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.

Our November tracking poll found that favorability of Medicaid Expansion across all parties has reached its highest point since passage in the Affordable Care Act seven years ago, but favorability has gained the most ground among Democrats.

With President Trump having declared the opioid epidemic a public health emergency, both the House and Senate are advancing legislation to address the crisis. A new issue brief from the Kaiser Family Foundation summarizes current federal legislative proposals related to Medicaid’s role in the opioid epidemic and identifies issues to…

As part of the new Kaiser Family Foundation/Episcopal Health Foundation 2018 Texas Health Policy Survey, this brief explores Texans’ views on health policy priorities at both the state and national level. It examines how Texas residents view state spending on health care and how they rank initiatives such as lowering health care costs, reducing maternal mortality, and funding for mental health care. It also explores Texans’ views on the Affordable Care Act and Medicaid, including personal connections to the Medicaid program and support for Medicaid expansion.

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…

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.

States that have expanded Medicaid under the Affordable Care Act generally have seen gains in coverage, improvements in access to and affordability of health care, and net fiscal benefits, a growing body of research and data show. At the same time, Medicaid expansion has not diverted coverage from traditional groups…

More than four years after the implementation of the Medicaid expansion included in the Affordable Care Act, debate and controversy around the implications of the expansion continue. Despite a large body of research that shows that the Medicaid expansion results in gains in coverage, improvements in access and financial security, and economic benefits for states and providers, some argue that the Medicaid expansion has broadened the program beyond its original intent diverting spending from the “truly needy”, offers poor quality and limited access to providers, and has increased state costs. New proposals allow states to implement policies never approved before including conditioning Medicaid eligibility on work or community engagement. New complex requirements run counter to the post-ACA movement of Medicaid integration with other health programs and streamlined enrollment processes. This brief examines evidence of the effects of the Medicaid expansion and some changes being implemented through waivers. Many of the findings on the effects of expansion cited in this brief are drawn from the 202 studies included in our comprehensive literature review that includes additional citations on coverage, access, and economic effects of the Medicaid expansion.