Medicaid

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Implications of CMS’s New “Healthy Adult Opportunity” Demonstrations for Medicaid

On January 30, 2020, the Centers for Medicare and Medicaid Services (CMS) released guidance inviting states to apply for new Section 1115 demonstrations known as the “Healthy Adult Opportunity” (HAO). These demonstrations would permit states “extensive flexibility” to use Medicaid funds to cover Affordable Care Act (ACA) expansion adults and other nonelderly adults covered at state option who do not qualify on the basis of disability, without being bound by many federal standards related to Medicaid eligibility, benefits, delivery systems, and program oversight. In exchange, states would agree to a limit on federal financing in the form of a per capita or aggregate cap. States that opt for the aggregate cap and meet performance standards could access a portion of federal savings if actual spending is under the cap. This issue brief explains the key elements of the HAO guidance and considers the implications of the new demonstrations.

Key State Policy Choices About Medicaid Home and Community-Based Services

State policy choices about Medicaid home and community-based services (HCBS) shape these benefits in important ways for the seniors and people with disabilities who rely on them to live independently in the community. This issue brief presents the latest data from the KFF’s annual survey of Medicaid HCBS program policies in all 50 states and DC.

Medicaid Home and Community-Based Services Enrollment and Spending

Medicaid continues to be the primary payer for home and community-based services (HCBS) that help seniors and people with cognitive, physical, and mental health disabilities and chronic illnesses with self-care and household activities. This issue brief presents Medicaid HCBS enrollment and spending data from KFF’s annual state survey and includes tables with detailed state-level data.

Medicaid Work Requirements and People with HIV

This data note examines the potential implications of work requirements for people with HIV, a population that relies heavily on Medicaid and for whom there are important clinical and public health reasons for maintaining consistent access to insurance coverage and HIV care.

Explaining Texas v. U.S.: A Guide to the Case Challenging the ACA

The Affordable Care Act’s (ACA) future continues to be uncertain as Texas v. U.S. (known as California v. Texas in the U.S. Supreme Court), remains unresolved. This issue brief answers key questions about the litigation as we await a decision from the Supreme Court about whether it will review the case.

What You Need to Know About the Medicaid Fiscal Accountability Rule (MFAR)

On November 18, 2019, the Trump Administration released a proposed rule called the Medicaid Fiscal Accountability Regulation (MFAR). This brief provides some context on Medicaid financing, an overview of current state payment and financing rules, the provisions in the rule and potential implications for considerations.

Women’s Health Insurance Coverage

This factsheet reviews major sources of coverage for women residing in the U.S. in 2018, discusses the impact of the ACA on women’s coverage, and the coverage challenges that many women continue to face

Pricing and Payment for Medicaid Prescription Drugs

Attention to high list prices continues at both the state and federal levels with a number of policy proposals aimed at lowering drug prices and there is renewed interest in drug prices and reimbursement within Medicaid. Changes made in 2016 to federal rules governing how state Medicaid programs pay for drugs aimed to make the prices paid more accurate, but increased reliance on pharmacy benefit managers (PBMs) pose challenges to drug price transparency. This brief explains Medicaid prescription drug prices to help policymakers and others understand Medicaid’s role in drug pricing and any potential consequences of policy changes for the program.