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  • Health Affairs Blog: Can States Substantially Reduce Medicaid Spending Through Delivery System And Financing Reform?

    Perspective

    In a Health Affairs blog post,  Joshua M. Wiener and Melissa Romaire of RTI International and MaryBeth Musumeci of the Kaiser Family Foundation examine whether states could successfully cope with substantial reductions in federal Medicaid funding under a per capita cap or block grant system by improving efficiency in the way both acute and long-term care are delivered and paid for under the program. A review of the evidence in literature suggests that large Medicaid…

  • State-by-State Estimates of Reductions in Federal Medicaid Funding Under Repeal of the ACA Medicaid Expansion

    Issue Brief

    Congressional debate around the Affordable Care Act (ACA) has recently included a proposal to repeal the ACA, including the provision allowing states to extend Medicaid to childless adults up to 138% FPL and providing enhanced federal funds for the Medicaid expansion. This brief provides estimates of changes in federal Medicaid funds and Medicaid coverage for adults covered through the ACA expansion if the expansion is eliminated starting in 2020. A repeal of the Medicaid expansion…

  • No Easy Choices: 5 Options to Respond to Per Capita Caps

    Issue Brief

    Under a per capita cap, per enrollee spending would be capped, but the total amount of federal dollars to states could vary with enrollment changes and states would not be able to impose enrollment caps. Faced with restrictions in federal financing, states would have to make hard choices. This brief outlines the key measures states could use to manage their budgets and the associated challenges under a per capita cap: raise taxes or make other…

  • Strategies to Reduce Medicaid Spending: Findings from a Literature Review

    Issue Brief

    This issue brief considers the feasibility of realizing substantial Medicaid cost savings through strategies aimed at improving delivery system and administrative efficiency. We review the literature about the potential for Medicaid cost savings from four strategies related to acute care services: (1) premiums, cost-sharing, and enrollee wellness incentives, (2) complex care management, (3) patient-centered medical homes, and (4) alternative payment models, and another four strategies related to long-term services and supports: (5) tightening financial eligibility…

  • State Data: What Has Happened to Health Coverage and Financing Under the Affordable Care Act?

    News Release

    As Congress presses forward with efforts to repeal and replace the Affordable Care Act, a new interactive map from the Kaiser Family Foundation provides a window into the changes in health insurance coverage and financing in each state under the 7-year-old law. The ACA increased enrollment in health insurance by expanding Medicaid, offering tax credits to low- and middle-income marketplace enrollees and reforming insurance market rules concerning coverage for people with pre-existing health conditions. Map…

  • Factors Affecting States’ Ability to Respond to Federal Medicaid Cuts and Caps: Which States Are Most At Risk?

    Issue Brief

    This issue brief examines the factors that could affect states’ ability to cope with reductions in federal Medicaid funding of the sort proposed in the House-passed American Health Care Act (AHCA), which would eliminate enhanced federal matching funds for the Affordable Care Act’s Medicaid expansion and convert Medicaid to a per capita cap or block grant system of financing.

  • What’s Really At Stake In the Medicaid Spending Debate

    From Drew Altman

    In this Axios column, Drew Altman highlights that the federal debate about the American Health Care Act’s Medicaid spending reductions will ultimately be a debate about every state’s general budget spending priorities, as states discuss whether to offset reductions in federal revenues with some combination of cuts to their Medicaid programs, increased taxes, and cuts to spending in other areas.

  • Implications of Reduced Federal Medicaid Funds: How Could States Fill the Funding Gap?

    Issue Brief

    In this analysis, we present three scenarios of reductions in federal Medicaid spending and examine fiscal implications if states fill these financing gaps to maintain their programs and if all reductions are assumed to be in full effect in FFY 2015 (the most recent year for which Medicaid spending data is available). To fill these gaps in financing and maintain current Medicaid programs, we assume states will increase state spending for Medicaid by increasing state…