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Analysis Finds that Medications for Hepatitis C and HIV/AIDS Are the Costliest Group of Outpatient Prescription Drugs for Medicaid, While Diabetes Drugs Have Posted the Sharpest Rise in Costs
Antiviral medications, including those that treat hepatitis C and HIV/AIDS, cost the Medicaid program more money (before rebates) than any other group of outpatient prescription drugs for each year from 2014 to 2017, according to a new KFF analysis. The analysis of utilization and spending trends finds that antivirals accounted…
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Utilization and Spending Trends in Medicaid Outpatient Prescription Drugs
Although the outpatient drug benefit accounts for only 6% of total Medicaid spending, drug spending has increased by double digits in recent years, and is expected to grow faster than most other Medicaid services in the next 10 years. This issue brief examines drug spending and utilization from 2014 through 2017 by drug group, brand and generic status, and biologic status to understand the causes for this increase in spending.
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Status of State Medicaid Expansion Decisions: Interactive Map
This page displays an interactive map of the current status of state decisions on the Affordable Care Act’s Medicaid expansion. Additional Medicaid expansion resources are listed (with links) below the map.
Issue Brief Read MoreSection 1115 Medicaid Demonstration Waivers: The Current Landscape of Approved and Pending Waivers
Section 1115 Medicaid demonstration waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. Waivers can provide states considerable flexibility in how they operate their programs, beyond what is available under current law. While there is great diversity in how states have used waivers over time, waivers generally reflect priorities identified by states and the Centers for Medicare and Medicaid Services (CMS). This brief answers basic questions about Section 1115 waiver authority and discusses the current landscape of approved and pending demonstration waivers.
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Medicaid in the Territories: Program Features, Challenges, and Changes
This brief draws on a survey of and interviews with Medicaid officials in U.S. Territories, as well as other research, to examine key issues and trends in their Medicaid programs. Territories differ from the states on key demographic, economic, and health status indicators. Unlike in the states, where federal Medicaid funding is not capped, and the federal share varies based on states’ per capita income, Medicaid in the territories is subject to a statutory cap and a fixed federal matching rate.
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Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State
This Medicaid waiver tracker page aggregates tracking information on pending and approved Section 1115 Medicaid waivers. It includes resources such as an overview map and figure, detailed waiver topic tables, and explanatory briefs.
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Interactive: How State Policies Shape Access to Abortion Coverage
This interactive map shows the increase in states with laws limiting abortion coverage in Medicaid and private insurance for the years 2000, 2010, and 2019, before and after the passage of the Affordable Care Act (ACA).
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Year End Review: December State Data for Medicaid Work Requirements in Arkansas
Arkansas is one of seven states for which CMS has approved a Section 1115 waiver to condition Medicaid eligibility on meeting work and reporting requirements and the first state to implement this type of waiver. CMS approved Arkansas’ waiver on March 5, 2018, and the new requirements took effect for the initial group of beneficiaries (those ages 30-49) on June 1, 2018. Unless exempt, enrollees must engage in 80 hours of work or other qualifying activities each month and must report their work or exemption status by the 5th of the following month using an online portal; as of mid-December, they also may report by phone. A review of monthly data related to the new requirements released by the Arkansas Department of Human Services shows that from September through December 2018, over 18,000 people were disenrolled for failure to comply with the new requirements for three months. In January, enrollees who were disenrolled can regain coverage (if they reapply) and enrollees ages 19 to 29 will be subject to the requirements for the first time. Those who fail to comply with the requirements for three months could lose coverage in April 2019. This brief looks at data for December 2018. Separate reports look at early implementation of the new requirements and enrollee experiences.
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How Quickly are States Connecting Applicants to Medicaid and CHIP Coverage?
In November 2018, CMS released new state data on MAGI Medicaid and CHIP application processing time. These data reflect continued progress in reporting of performance indicators that CMS established in 2013 to facilitate data-driven program management and improvement.
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CMS’s 2018 Proposed Medicaid Managed Care Rule: A Summary of Major Provisions
On November 14, 2018, the Centers for Medicare and Medicaid Services (CMS) proposed revisions to the Medicaid managed care regulations with public comments due by January 14, 2019. CMS previously finalized a major revision to these regulations in 2016. The November 2018 proposed rule is not a wholesale revision of the 2016 final rule but proposes changes in the following key areas: network adequacy, beneficiary protections, quality oversight, and rate setting and payment.
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