Medicaid

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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.

Medicaid: What to Watch in 2020

Medicaid, the provider of health insurance coverage for about one in five Americans and the largest payer for long-term care services in the community and nursing homes, continues to be a key part of health policy debates at the federal and state level. Key Medicaid issues to watch in 2020 include: Medicaid expansion developments; Section 1115 waiver activity; enrollment and spending trends; benefits, payment and delivery system reforms, and the implications of the 2020 elections.

The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid

In states that do not implement the Medicaid expansion under the Affordable Care Act (ACA), many adults will fall into a “coverage gap” of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits. Nationwide, 2.3 million poor uninsured adults are in this situation. This brief presents estimates of the number of people in non-expansion states who could have been reached by Medicaid but instead fall into the coverage gap and discusses the implications of them being left out of ACA coverage expansions.

Health Policy in 2020 Will Be Made in the States

With a questionable outlook for 2020 passage of legislation on prescription drug pricing and surprise medical bills, Drew Altman says the real action to watch in health policy is likely to be in the states.

10 Things to Know about Medicaid Managed Care

This brief describes key themes related to the use of comprehensive, risk-based managed care in the Medicaid program and highlights data and trends related to MCO enrollment, service carve-ins, spending, MCO parent firms, and state and plan activity related to quality, value-based payments, and the social determinants of health.