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Medicaid Home and Community-Based Services: Results From a 50-State Survey of Enrollment, Spending, and Program Policies

This report summarizes the national trends to emerge from the latest (2014) enrollment and spending data for the three main Medicaid home and community-based services (HCBS) programs: (1) the mandatory home health services state plan benefit, (2) the optional personal care services state plan benefit, and (3) optional § 1915 (c) HCBS waivers. It also highlights key findings on 2016 program policies, such as waiting lists, managed long-term services and supports, and provider payment rates.

Medicaid: What to Watch in 2018 from the Administration, Congress, and the States

Medicaid provides health insurance coverage for about one in five Americans and is the largest payer for long-term care services in the community and nursing homes. Efforts in 2017 to repeal and replace the Affordable Care Act (ACA) and cap federal financing for Medicaid were unsuccessful but help to set the stage for 2018. As 2018 begins, there is a focus on administrative actions using Medicaid Section 1115 demonstration waivers, state actions on Medicaid expansion, and funding for the Children’s Health Insurance Program (CHIP) and other federal health care priorities. Medicaid in 2018 is also likely to continue to be part of both federal and state budget deliberations. Pressures to control the federal deficit may reignite efforts to reduce or cap federal Medicaid spending. In addition, Governors will soon release proposed budgets for state FY 2019 that will need to account for uncertainty around CHIP and Medicaid, changes in the economy and the effects of the recent tax legislation as well as funding for rising prescription drugs and initiatives to combat the opioid epidemic. This brief examines these issues.

Approved Changes to Medicaid in Kentucky

On January 12, 2018, the Centers for Medicare and Medicaid Services (CMS) approved a Section 1115 demonstration waiver in Kentucky, entitled “Kentucky Helping to Engage and Achieve Long Term Health” or KY HEALTH. On the same day that CMS approved Kentucky’s waiver, Governor Bevin issued an executive order directing the state to terminate the Medicaid expansion if a court decides that one or more of the waiver provisions are illegal and cannot be implemented. This fact sheet summarizes key provisions of Kentucky’s approved waiver.

What Are States Proposing for Work Requirements in Medicaid?

With the approval of Kentucky’s Medicaid expansion waiver, the Centers for Medicare and Medicaid Services (CMS) has for the first time granted a state permission to make Medicaid eligibility conditional on meeting a work requirement. Nine other states have waivers pending at CMS that would impose work requirements, including Arizona,…

Medicaid and Work Requirements: New Guidance, State Waiver Details and Key Issues

On January 11, 2018, the Centers for Medicare and Medicaid Services (CMS) issued a State Medicaid Director Letter providing new guidance for Section 1115 waiver proposals that would impose work requirements (referred to as community engagement) in Medicaid as a condition of eligibility. This issue brief provides an overview of this CMS guidance and summarizes states with work requirement provisions/requests as part of pending and approved Section 1115 Medicaid waivers.

New KFF Resource Tracks Developments in States’ Section 1115 Medicaid Waivers

A new resource from the Kaiser Family Foundation enables users to keep abreast of Section 1115 Medicaid waivers that are pending or have been approved by the Centers for Medicare and Medicaid Services. KFF’s Medicaid waiver tracker includes interactive maps that allow users to view states’ approved and pending waivers…

Understanding the Intersection of Medicaid and Work

Recent state requests for waivers of federal Medicaid law seek to make Medicaid eligibility contingent on work, and the Trump Administration has indicated a willingness to approve such waivers. This issue brief provides data on the work status of the nearly 25 million non-elderly adults without SSI enrolled in Medicaid to understand the potential implications of work requirement proposals in Medicaid. It shows that the majority of adults in this group are already working, and those who are not report major impediments to their ability to work such as illness or care-giving responsibilities.

Key Themes in Medicaid Section 1115 Behavioral Health Waivers

State interest in Medicaid Section 1115 behavioral health waivers, including mental health and substance use disorders, remains high. As of November, 2017, there are 15 approved and 11 pending behavioral health waivers in 22 states. This issue brief describes recent waiver activity in four areas: using Medicaid funds to pay for substance use and/or mental health services in “institutions for mental disease” (IMDs), expanding community-based behavioral health benefits, expanding Medicaid eligibility to cover additional people with behavioral health needs, and financing delivery system reforms.

How Medicaid Section 1115 Waivers Are Evolving: Early Insights About What to Watch

While efforts to pass major federal legislation to repeal and replace the Affordable Care Act (ACA) and restructure and reduce federal Medicaid financing may be on hold temporarily, the focus of the Centers for Medicare and Medicaid Services (CMS) and states is expected to turn to achieving significant Medicaid program changes through Section 1115 demonstration waivers. This issue brief presents three questions to help analyze the evolution of federal waiver policy as new waiver proposals and decisions emerge.

The Henry J. Kaiser Family Foundation Headquarters: 2400 Sand Hill Road, Menlo Park, CA 94025 | Phone 650-854-9400
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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.