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  • “Partial Medicaid Expansion” with ACA Enhanced Matching Funds: Implications for Financing and Coverage

    Issue Brief

    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 Home & Community-Based Services: People Served and Spending During COVID-19

    Issue Brief

    This issue brief presents FY 2020 state-level data on the number of people receiving Medicaid HCBS and HCBS spending. This is the latest data available, and the first since the onset of the COVID-19 pandemic. The data were collected in KFF’s 19th survey of state officials administering Medicaid HCBS programs in all 50 states and DC. A related brief presents the latest data and highlights themes in key state policy choices about optional HCBS.

  • State Policy Choices About Medicaid Home and Community-Based Services Amid the Pandemic

    Issue Brief

    This issue brief presents findings on key state policy choices about Medicaid HCBS in FY 2020. This is the latest data available, and the first since the onset of the COVID-19 pandemic. The data were collected in KFF’s 19th survey of state officials administering Medicaid HCBS programs in all 50 states and DC. A related brief presents the latest state-level data about the number of people receiving HCBS and HCBS spending

  • Disability and Technical Issues Were Key Barriers to Meeting Arkansas’ Medicaid Work and Reporting Requirements in 2018

    Issue Brief

    This issue brief analyzes the impact of the four measures intended to safeguard coverage for people with disabilities and others who should not have been subject to the work and reporting requirements. It draws on data newly available from Arkansas’ 2018 annual waiver report to CMS and monthly data released by the state while the requirements were in effect. The data reveal that few people used these safeguard measures relative to the number of people who lost coverage due to the new requirements. Among those who accessed the safeguards, the vast majority did so due to disability/other health issues or technical issues such as those related to reporting.

  • New Analysis Illustrates Potential Impact of Medicaid Work Requirements on Coverage if Implemented Nationally as Called for by House Budget Committee and Senate Legislation

    News Release

    As a number of states pursue Medicaid waivers to require certain beneficiaries to work in order to receive benefits, the House Budget Committee passed a budget resolution this month calling for the enactment of Medicaid work requirements in all states, a goal also advanced in proposed legislation in the Senate by Sen.

  • From Ballot Initiative to Waivers: What is the Status of Medicaid Expansion in Utah?

    Issue Brief

    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 additional amendments that the state has submitted to CMS, including most recently a request for enhanced ACA federal matching funds for an expansion to 138% FPL with an enrollment cap.

  • A First Look at North Carolina’s Section 1115 Medicaid Waiver’s Healthy Opportunities Pilots

    Issue Brief

    Medicaid funds typically cannot be used to pay for non-medical interventions that target the social determinants of health. However, in October 2018, CMS approved North Carolina’s Section 1115 waiver which provides financing for a new pilot program, called “Healthy Opportunities Pilots,” to cover evidence-based non-medical services that address specific social needs linked to health/health outcomes. The pilots will address housing instability, transportation insecurity, food insecurity, and interpersonal violence and toxic stress for a limited number of high-need Medicaid enrollees. This brief summarizes key features of the pilots.