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Annual Survey Explores Medicaid in the Reform Era

October 16, 2014

Kaiser Commission on Medicaid and the Uninsured

States expanding Medicaid under the Affordable Care Act expect 18 percent enrollment growth in fiscal year 2015, with federal funds picking up most of the cost. This is just one of the findings in “Medicaid in an Era of Health & Delivery System Reform: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2014 and 2015.”

This report, released Oct. 14 by the Kaiser Commission on Medicaid and the Uninsured (KCMU), provides an in-depth examination of the changes taking place in state Medicaid programs across the country.

The findings in this report are drawn from the 14th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the KCMU and Health Management Associates (HMA), with the support of the National Association of Medicaid Directors. This report highlights policy changes implemented in state Medicaid programs in FY 2014 and those planned for implementation in FY 2015 based on information provided by the nation’s state Medicaid directors.

HMA Managing Principals Vern Smith, Eileen Ellis and Kathy Gifford authored the report outlining the survey findings in conjunction with Robin Rudowitz and Laura Snyder from the Kaiser Family Foundation. Key areas covered in the report include changes in eligibility and enrollment, delivery systems, provider payments and taxes, benefits, pharmacy programs, program integrity and program administration.

Two additional issue briefs were developed as well:

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Implementing the ACA: Medicaid Spending & Enrollment Growth for FYs 2014-2015

October 16, 2014

Kaiser Commission on Medicaid and the Uninsured

This issue brief was released Oct. 14 by the Kaiser Commission on Medicaid and the Uninsured (KCMU) in conjunction with its 14th annual budget survey of Medicaid officials, “Medicaid in an Era of Health & Delivery System Reform: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2014 and 2015.”

HMA Managing Principals Vern Smith, Eileen Ellis and Kathy Gifford authored this brief with Robin Rudowitz and Laura Snyder from the Kaiser Family Foundation.

Executive Summary

Medicaid spending and enrollment growth are affected by both the economy and policy decisions determining who is covered under the program, the services provided and payments for care. For more than a decade, economic conditions, including two major recessions, were the primary driver of changes in Medicaid spending and enrollment. In FY 2014 and in budgets adopted for FY 2015, enrollment and spending have grown with implementation of the major coverage provisions in the Affordable Care Act (ACA), including the federally financed Medicaid expansion. This report provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2014 and 2015 (FY 2014 and FY 2015) and an overview of Medicaid financing. Findings are based on interviews and data provided by state Medicaid directors as part of the 14th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) with Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth and compare expansion and non-expansion states.

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Putting Medicaid in the Larger Budget Context: An In-Depth Look at Four States in FY 2014 and 2015

October 16, 2014

Kaiser Commission on Medicaid and the Uninsured

This issue brief was released Oct. 14 by the Kaiser Commission on Medicaid and the Uninsured (KCMU) in conjunction with its 14th annual budget survey of Medicaid officials, “Medicaid in an Era of Health & Delivery System Reform: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2014 and 2015.”

HMA Managing Principals Eileen Ellis and Kathy Gifford and HMA Senior Consultant Jenna Walls authored this brief with Robin Rudowitz and Laura Snyder from the Kaiser Family Foundation.

Medicaid has long-played an important role in the US healthcare system, accounting for one in every six dollars of all U.S. health care spending while providing health and long-term services and supports coverage to over 66 million low-income Americans. Medicaid also plays an important role in states budgets as both an expenditure item and the largest source of federal revenue for states.

The years 2014 and 2015 will stand out as a time of significant change and transformation for Medicaid programs. With the economy improving from the lingering effects of the Great Recession, Medicaid programs across the country were focused primarily on implementing a myriad of changes included in the Affordable Care Act (ACA), pursuing innovative delivery and payment system reforms to help assure access, improve quality and achieve budget certainty, and continuing to administer this increasingly complex program.

However, these changes to Medicaid policy, spending and enrollment take place in the larger context of states budgets. Unlike the Federal government, states generally have balanced budget requirements, taking into account the amount of revenue coming in from a state’s own resources as well as federal revenues. State lawmakers must balance competing priorities across budget expenditure categories. Even in years of economic growth, state lawmakers face this pressure of balancing priorities.

This report provides an in-depth examination of Medicaid program changes in the larger context of state budgets in four states:

  • Michigan
  • Utah
  • Virginia
  • West Virginia

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Medicaid Health Homes: A Profile of Newer Programs

August 11, 2014

Kaiser Commission on Medicaid and the Uninsured

Mike Nardone | Managing Principal | Contributor

HMA Managing Principal Mike Nardone and Julia Paradise authored the recently released issue brief, “Medicaid Health Homes: A Profile of Newer Programs” for the Kaiser Commission on Medicaid and the Uninsured (KCMU).

The Affordable Care Act (ACA) established a new state option in the Medicaid program to implement “health homes” for individuals with chronic conditions, giving states a new tool to develop models of care designed to improve care coordination and reduce costs for high-need populations. In August 2012, the KCMU issued a brief examining the first six health home programs. This update profiles health home programs in the nine states that have taken up the option in the intervening two years – Alabama, Idaho, Maine, Maryland, Ohio, South Dakota, Washington, Wisconsin, and Vermont.

States have implemented health home programs in a variety of ways, reflecting different targeting priorities, underlying delivery and payment systems, and visions of delivery system reform, as well as other state-level factors. This issue brief identified both themes and diversity in the more recent health home programs in a number areas, including geographic scope, target population, health home providers, payment, fee for service versus managed care, and HIT.

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Care Coordination for California’s Children and Youth with Special Health Care Needs: Building Blocks from other States

July 15, 2014

Lucile Packard Foundation for Children's Health

For the more than one million children and youth with special health care needs (CYSHCN) in California, care coordination can be critical for linking them and their families to needed medical, developmental, behavioral, educational, and social services, and for providing logistical assistance and emotional support. A review of care coordination programs around the country revealed that while there is no single accepted model for care coordination, the essential building blocks are similar across programs: eligibility guidelines and determination, services and standards, payment/reimbursement mechanisms, financing, and oversight/monitoring. These represent decision points for California policymakers, officials, and other stakeholders as they consider ways to improve care coordination for CYSHCN. This report presents options for each building block based on seven care coordination programs in six other states, considerations given California’s unique environment, and lessons from other programs about key “ingredients” for an effective, sustainable care coordination system.

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Medicaid Enrollment Snapshot: December 2013

June 5, 2014

Kaiser Commission on Medicaid and the Uninsured

On June 3, the Kaiser Commission on Medicaid and the Uninsured released its “Medicaid Enrollment Snapshot: December 2013” issue brief.

Authored by Kaiser’s Laura Snyder and Robin Rudowitz and HMA’s Eileen Ellis and Dennis Roberts, the report indicates that as of December 2013, nearly 55.4 million people were enrolled in Medicaid. That’s an increase of 585,000 enrollees from the prior year, but the slowest growth since before the Great Recession.

The report examines changes in monthly Medicaid enrollment from December 2012 to December 2013 and the factors that influenced those changes in a variety of ways.

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