5 State decisions to expand Medicaid were particularly consequential for FQHCs and the patients they serve, as those receiving care at FQHCs in expansion states experienced large gains in insurance coverage . Finally, given that the savings outside Medicaid amount to a fraction of a percent of non-Medicaid spending, it would require a much larger data set to find statistically significant results. Medicaid enrollment growth peaked in FY 2015 due to the implementation of the ACA and has tapered each year since, dropping to -0.6% in FY 2018 and -1.7% in FY 2019. MAP: Medicaid Expansion and Work Requirement Waivers - Infogram. By June 2021, more than 555,000 people had gained coverage in Virginia under Medicaid expansion (including a significant number who became eligible for Medicaid due to a job/income loss stemming from the COVID pandemic). Matt Powers, Sharon Silow-Carroll, and Jack Meyer, Medicaid Expansion in Missouri — Economic Implications for Missouri and Interviews Reflecting Arkansas, Indiana, and Ohio Experiences (Health Management Associates, Jan. 2020). Medicaid is a joint federal and state program that, together with the Children's Health Insurance Program (CHIP), provides health coverage to over 72.5 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Building on the Evidence Base: Studies on the Effects of Medicaid Expansion, February 2020 to March 2021 2 Introduction The new financial incentive for expansion in the American Rescue Plan Act (ARPA) of 2021 has reignited debate on Medicaid expansion under the Affordable Care Act (ACA) in the twelve states that have not adopted the expansion. For residents of states that haven’t expanded Medicaid, their federal tax dollars are being used to pay for Medicaid expansion in other states, while none of the Medicaid expansion funds are coming back to their own states. 29. Other analyses using different methods to estimate savings within Medicaid find similar effects. Individuals can also apply by submitting a paper application by telephone toll free (844) 854-4825 or 711 (TTY) for people with hearing impairments, mail, or in-person at their Human Service Zone office (formerly known as county social service office).. For instance, Exhibit 6 presents data on state corrections’ department health care spending through FY2015. You can click on a state on this map to see current Medicaid-related legislation: In Maine, Utah, Idaho, Nebraska, and Oklahoma, Medicaid expansion came about as a result of ballot initiatives passed by voters. A primarily GOP-led expansion bill (with premiums and a work requirement) is being considered by lawmakers, and Cooper vetoed the GOP-backed budget in 2019 because it didn't include Medicaid expansion. Read our new issue brief to learn more and explore the data. Even though Virginia expected (and has realized) substantial savings associated with Medicaid expansion, it still implemented a provider fee to cover its full statutory cost. Funds and State Costs, SFYs 2020-2023 . Several studies have calculated the impact of Medicaid expansion on states’ economies.20 Most employ a statistical model used to estimate the number of jobs and amount of income generated by an event like Medicaid expansion. Organized in a unique and convenient Q&A format, this book helps professionals find exactly what they're looking for quickly and easily to solve clients' important planning issues in a timely manner. At the start of 2020, 37 states had adopted the ACA Medicaid expansion. Now that the Biden administration has indicated that the associated work requirement approval might be rescinded, the future of Georgia’s partial Medicaid expansion is uncertain. So for the time being, Medicaid work requirements are essentially a no-go, as they would cause a non-compliant enrollee’s Medicaid coverage to be involuntarily terminated. Missouri voters approved a similar measure and it was slated to take effect in mid-2021 as well, but GOP lawmakers in the state refused to allocate funding, and the implementation has been suspended. More economic activity generally yields more state revenue.23 Recent estimates from Louisiana, Michigan, and Montana suggest that the economic impacts of Medicaid are sufficient to generate tax revenues equal to 30 percent to 37 percent of states’ expansion costs.24 These same forces also boost local tax revenues. Meanwhile, the rate of uninsured patients in other states fell from 52% to 42%. h�b```�����@(�����q� �oh\����y.�e!u� 3��T00p]j���~Q��=�6��� p#x��p*� Data: Ohio Office of Budget and Management analysis, July 2018. The healthinsurance.org website is operated on behalf of IHC Specialty Benefits, Inc., a licensed insurance agency. In 2018, total state spending on traditional Medicaid was more than $229 billion, and over $2 billion in the median state. It is important to note that these taxes do not suggest that states do not also reap the savings described above. Pregnant women: $13.0 million . Section 6008 of the FFCRA provides states with a 6.2 percentage point increase in their federal Medicaid matching funding for the duration of the COVID public health emergency period, as long as the state Medicaid program: CMS previously interpreted this last point to mean that in order to receive the increased federal Medicaid funding, “a state must keep beneficiaries enrolled in Medicaid, if they were enrolled on or after March 18, 2020, with the same amount, duration, and scope of benefits,” and that “states could not subject such beneficiaries to any increase in cost-sharing or beneficiary liability for institutional services or other long-term services and supports (LTSS) during this time period.”. On June 30, 2020, the Oklahoma Medicaid Expansion Initiative, State Question 802, passed by a majority vote to expand Medicaid eligibility to adults ages 19-64 whose income is 138% (133% with a 5% disregard) of the federal poverty level or lower. While it is difficult to establish a precise estimate of the savings expansion creates outside of Medicaid, ample evidence suggests it does allow states to reduce spending in some non-Medicaid areas and offset some of the cost of expansion. The final column illustrates how much of states’ expected expansion costs in 2020 might be offset by savings within Medicaid. While effects vary across states, studies of this type find that Medicaid expansion generates savings that average to 4 percent to 5 percent of traditional Medicaid spending, similar what we found in our difference-in-differences analysis. The Supreme Court's 2012 ruling on the Affordable Care Act (ACA) allowed states to opt out of the law's Medicaid expansion, leaving each state's decision to participate in the hands of the nation's governors and state leaders.. Some states favor changes that would put increased limits on Medicaid eligibility – such as work requirements and lifetime caps – while other states have considered legislation that would give currently ineligible residents a chance to buy-in. Even absent effects of the COVID-19 pandemic and economic crisis, if the 15 remaining states had expanded Medicaid eligibility in 2020, 3.9 . Issue: The impact of Medicaid expansion on state budgets is a concern cited by policymakers in nonexpansion states. Data: Virginia Department of Medical Assistance Services, Overview of the Governor’s Introduced Budget: Presentation to Senate Finance Committee Subcommittee on Health and Human Resources (State of Virginia, Jan. 8, 2018); and Senate Finance & Appropriations and House Appropriations Committees (State of Virginia, 2020). This amount is similar to the savings reported in Exhibit 5, suggesting that the savings reported there are fairly typical. Covered adults include individuals ages 19-64 with income at or below 138% of the federal poverty limit. In total, more than 3.4 billion dollars will be compensated by fixing the coverage . In 2020, Missouri residents voted to expand Medicaid, the federal health-insurance program for the poor.Under the terms of the 2010 Affordable Care Act, the federal government contributes more generous funding to states that offer expanded access to the program to their residents. Robin Rudowitz et al., Medicaid Enrollment and Spending Growth: FY 2019 and 2020 (Henry J. Kaiser Family Foundation, Oct. 2019). Andrea Callow, Charging Medicaid Premiums Hurts Patients and State Budgets (Families USA, Apr. ), but the myth of the “welfare queen” (or king) persists, and Medicaid work requirements are seen by some as a solution to a perceived problem. Any attempt at quantifying non-Medicaid budget savings due to expansion faces several hurdles. This includes more than 60% of working families who would receive coverage. The second column excludes states that expanded during 2015–17. Methods: Using historical data, projections of cost, and difference-in-differences analysis, we estimate the impact of expanding eligibility for Medicaid on . The federal government and the states share responsibility for financing Medicaid, although the matching rate is higher for adults eligible under the Medicaid expansion.In fiscal year (FY) 2018, total Medicaid spending was estimated at $616.1 billion, including $74.2 billion in spending on newly eligible adults (CMS 2020). The populations affected vary from state to state, depending on the specifics of their traditional Medicaid programs. Specifically, Medicaid will cover inpatient stays of at least 24 hours in a medical facility outside the state correctional system, like an acute care hospital. The American Rescue Plan, enacted in March 2021, provides these holdout states with additional federal funding if they choose to expand Medicaid, although Oklahoma is thus far the only state taking advantage of this — and their Medicaid expansion was already slated to take effect in the summer of 2021, due to a voter-approved ballot measure that passed in 2020. Utah, Idaho, and Nebraska approved expansion initiatives on their 2018 ballots, Virginia lawmakers approved Medicaid expansion, which took effect in January 2019, Twelve states have received federal approval for Medicaid work requirements, Some states are attempting to change Medicaid. The Daily Briefing editorial team has been tracking where each state stands on Medicaid expansion, combing through lawmakers' statements, press releases and media coverage. The new rules take effect immediately, but public comments were being accepted through January 4. See, for instance, Deborah Bachrach et al., States Expanding Medicaid See Significant Budget Savings and Revenue Gains (Robert Wood Johnson Foundation, Mar. All states—including the District of Columbia—provide data each month about their Medicaid and Children's Health Insurance Programs (CHIP) eligibility and enrollment activity. This is notable given that Mississippi was one of just three states in the U.S. to lose population between 2010-2020. Data on state correctional health care spending obtained from Kil Huh et al., Prison Health Care: Costs and Quality — How and Why States Strive for Higher Performing Systems (Pew Charitable Trusts, Oct. 2017). Some other states followed suit to varying degrees over the coming years, but have since transitioned back to a more traditional approach (Medicaid fee-for-service or Medicaid managed care). Arkansas is the only state that still uses the private option approach. Studies that examine the fiscal impact of Medicaid expansion on specific states or the effects across all states find consistent results: expansion leads to significant budget savings and significant revenue increases (even without imposing additional taxes). Since 2010, the number of states that have accepted ACA’s Medicaid expansion has steadily grown – from just a handful by 2012 to 37 states and DC as of mid-2021. The idea was that everyone with household incomes up to 133 percent of the federal poverty level (FPL) would be able to enroll in Medicaid. Global Medicaid Expansion Market . Coverage and Access, Government Programs & Policies, And the bipartisan Medicaid expansion legislation that Kansas lawmakers considered in 2020 called for a work referral program instead of a work requirement. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts. We present results from two different specifications in the table. DATA AND METHODS We analyze prepandemic federal Medicaid/CHIP spending for 2020 under current law and a scenario where each state receives a share of total Medicaid/CHIP spending equal to https://doi.org/10.26099/5q66-1k77, Coverage and Access, Government Programs & Policies, State Health Policy, Medicaid, Medicaid Expansion, 1666 K Street, NW, Suite 1100 Medicaid expansion can provide states with additional resources to fund other priorities or cut taxes. But thus far, CMS has not approved this provision for any states. Previous. Its official savings estimates amount to only 24 percent of the cost of expansion in FY2021. States can save from 15 cents to 40 cents on every dollar of care it can shift to expansion (assuming 2020 expansion match rates). She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Report: TX May Lose 362,000 Health Jobs Due to High Uninsured Rate. Since Medicaid expansion took effect, the share of opioid-related hospitalizations in which the patient . And if their original category was not minimum essential coverage but did provide access to zero-cost COVID testing and treatment, they could only be moved to another category that also provides that benefit. The Medicaid statute requires states to make disproportionate share hospital (DSH) payments to hospitals treating large numbers of low-income patients. 2Voters in Missouri and Oklahoma approved Medicaid expansion in 2020. Being in the coverage gap means you have no realistic access to health insurance. Maine expanded Medicaid as soon as Governor Mills took office in early 2019. Most expansion states reported relying on general fund Lawmakers in Colorado and Nevada are working on public option legislation during the 2021 session. The idea was that people with income above 400 percent of the poverty level would be able to afford coverage without subsidies, but that has not proven to the case. Shifting 6 percent of corrections health care spending to Medicaid and assuming the state pays for 10 percent of these costs, the net reduction in state spending amounts to roughly 5 percent of the expected costs of Medicaid expansion. Finally and most discouragingly, in 2018, nearly 48 percent of deaths among people with HIV were in the South.15 Rates of prEp use are lower in the south, which makes the epidemic harder to contain. These are people with incomes below the poverty level, so they are not eligible for subsidies in the exchange. States that do not expand Medicaid do not receive a special tax break or grant equal to the amount of federal Medicaid dollars they have forgone. During 2014–17, Medicaid expansion was associated with a 4.4 percent to 4.7 percent reduction in state spending on traditional Medicaid. Among many other things, the law addresses a wide range of insurance-related issues. While researchers have a clear understanding of how expansion may reduce states’ traditional Medicaid spending, calculating the magnitude of these savings is difficult. In this brief, we summarize prior research documenting the impacts of Medicaid expansion on state budgets, focusing on a handful of states that have recent projections for expansion’s expected costs in 2020 and beyond, when states are responsible for 10 percent of the costs of expansion. Expansion took effect in Virginia and Maine in 2019, in Utah, Idaho, and Nebraska in 2020, and in Oklahoma in 2021. Data: All estimates for FY2021 from Koorstra (2018) except taxes on increased economic activity, which comes from Levy et al. Updated Insights from 2015 Cost Report Data (Urban Institute, Apr. Second, states that realize savings outside Medicaid may choose not to reduce total spending and instead transfer savings to other parts of the state budget. The state announced plans to transition about 21,000 of its Insure Oklahoma members to the Medicaid expansion program, effective July 1, 2021. So as noted above, Medicaid work requirements would still prevent a state from receiving the additional federal funding. But that provision was later removed from the state’s Medicaid renewal proposal, and the waiver approval that was granted by CMS in December 2018 did not include a work requirement. 9. Finally, expansion may increase state revenues due to taxes related to Medicaid expansion or taxes on the increased economic activity it triggers. While this is large in absolute terms, it is still small relative to state spending on traditional Medicaid. California, Oregon, and Illinois recently implemented taxes (provider/insurer and/or MCO taxes). Bachrach et al., States Expanding, Mar. A federal judge has overturned federally-approved Medicaid work requirements in Arkansas, Kentucky, New Hampshire, and Michigan, citing the fact that numerous people would lose coverage under the terms of the work requirements, and the government had done nothing to ameliorate that problem. If an individual does not qualify for Medicaid, the individual . Overview. In expansion states, 36.3% of those in the study reported declines in their physical health compared with 38.1% in non-expansion states. Nevada lawmakers passed legislation to allow Medicaid buy-in during the 2017 legislative session, but the governor vetoed it. Increasingly, health care products can be purchased electronically.Yet the promise of e-health remains largely unfulfilled. Digital Medicine investigates the factors limiting digital technology's ability to remake health care. Thus, at the margin, the decision to expand Medicaid is in part a decision to bring a substantial amount of money (and the associated economic activity) into the state’s economy. Publication Details. For mental health, 36.8% reported declines in expansion states while 38.9% did so in non-expansion states. Some states have chosen to leverage Medicaid expansion to raise revenue that allows them to fund other priorities or reduce other taxes. As a late-expanding state, it could learn from earlier states when developing estimates for the likely fiscal impacts of expansion. Most people who receive Medicaid benefits are either already working or would be exempt from work requirements (due to being disabled, taking care of a minor child, pregnant, etc. These taxes are expected to generate $248 million in FY2021, or 46 percent of the state’s share of expansion costs. So far, Medicaid expansion ballot initiatives have passed in 100% of the states that have had them on the ballot (Montana voters did not approve a 2018 measure that would have provided ongoing funding for the state’s Medicaid expansion — which was already in effect — but this did not affect the state’s Medicaid expansion, which continues to be available to eligible residents). OvbYd��QF�F��^���:�V)BSj�5�Wh�m3^4���-�K�ׂ�Rd�W�x�$�n�����)�,r��P�F���,�1����'��B�׶��z9,�-�u���.|ҰO���g �Lyv��}�:n/@VXp��kuN���?�3&�xj�n�~]�I���]G��kw?��4��ׁ�A����3� But work requirements were only in effect in Utah and Michigan as of January 2020, and both have since been suspended (Utah’s as a result of the COVID-19 pandemic, and Michigan’s as a result of a court order). Learn More. In the rest of the states where Medicaid work requirements have been approved, they have either been overturned by a judge, paused by state administrators, or are not yet scheduled to take effect. Given that states pay between 25 percent and 50 percent of the cost for a traditional Medicaid beneficiary but only 10 percent of the cost for an expansion beneficiary, these savings can be substantial. Medicaid Expansion. According to the most recent 50-state Medicaid Budget Survey, 11 states fund the state portion of expansion with new or expanded taxes or fees.16 However, nearly every state has at least one type of provider fee used to pay for Medicaid, and several have expanded or changed these taxes/fees since Medicaid expansion (such as California, Oregon, and Illinois).17 These taxes or fees are often explicitly tied to Medicaid expansion. Several states that have not expanded Medicaid are seeking federal permission to impose Medicaid work requirements, despite the fact that their Medicaid populations are comprised almost entirely of those who are disabled, elderly, or pregnant, as well as children. Both states were scheduled to implement expansion beginning July 1, 2021. The net impact on their general funds is much smaller than expansion’s costs. Eventually, Medicaid was available in every state, but it certainly didn’t happen everywhere in the first year. In the IFC, the administration implemented a new approach, designed to give states more flexibility but also panned by critics as allowing states to reduce Medicaid benefits in the midst of a global health crisis. A trusted independent health insurance guide since 1994. What are states' views on the fiscal implications of the Medicaid expansion on state budget planning? In FY2017, states began paying a share of the cost of expansion (5 percent), which grew each year between FY2017 and FY2020. The proposal was approved by CMS in October 2020, although CMS declined to provide full Medicaid expansion funding, given that Georgia is only partially expanding Medicaid. How does Medicaid expansion generate savings to offset such costs? Found inside – Page 170The Trump administration appealed this ruling, but in February 2020, the U.S. Court of Appeals for the D.C. Circuit ... Even after the introduction of the new work requirement, support for Medicaid expansion across the state remained ... The House Fiscal Agency includes the elimination of its Adult Benefits Waiver, but it does not include any other potential savings within Medicaid as described above. If you have questions or comments on this service, please contact us. (A similar partial expansion — with a request for full Medicaid expansion funding — was proposed by Utah in 2019 and rejected by the federal government, with Utah later agreeing to full expansion of Medicaid; CMS has maintained a clear policy, under both the Obama and Trump administrations, of only providing the enhanced federal funding if a state fully expands Medicaid). Through the end of 2016, the federal government fully funded Medicaid expansion. Michigan’s official estimates also do not account for increased revenues attributable to increased economic activity. How will Medicaid expansion benefit rural areas of the state? Ohio’s experience differs to some degree. Adults: non-expansion, non-disabled, under age 65. Bachrach et al., States Expanding, Mar. However, the connections are often less clear. In Texas – home to more than a quarter of those in the coverage gap nationwide – a board of 15 medical professionals appointed by then-Governor Rick Perry recommended in November 2014 that the state accept federal funding to expand Medicaid, noting that the uninsured rate in Texas was “unacceptable.” But no real progress towards Medicaid expansion has been made since then, and U.S. census data indicated that 18.4 percent of Texas residents were uninsured in 2019 – the highest rate in the country. additional federal funding if they choose to expand Medicaid, proposed by Utah in 2019 and rejected by the federal government, Most people who receive Medicaid benefits are either already working or would be exempt from work requirements, do not consider Medicaid work requirements to be in line with the mission of the Medicaid program, Supreme Court pulled the case from its list of scheduled arguments, residents are not currently required to comply with it, the state’s community engagement requirements, also directed the state to seek federal permission for a work requirement, halted the implementation of the work requirement in late June, wouldn’t be approved in time for the expansion start date, delayed implementation until after the COVID emergency period ends, bipartisan Medicaid expansion legislation, panned by critics as allowing states to reduce Medicaid benefits in the midst of a global health crisis, considerable controversy about the concept of “validly enrolled,”, Alabama wants to impose a strong work requirement, more than a quarter of those in the coverage gap. In other years, it is associated with a decrease in total non-Medicaid spending. In 2018, Virginia lawmakers passed a budget that includes Medicaid expansion, with coverage that took effect in January 2019. The experience of the states that have expanded Medicaid shows that implementing expansion in the final 14 states would mean millions more people - many newly in desperate need - would get affordable coverage and states would also get a huge infusion of federal funds on top of COVID-19 stimulus to pay for the coverage. For a family of three, that’s only $231 per month (and yet, Alabama wants to impose a strong work requirement on those parents who are currently eligible for coverage). This book shares up-to-date Medicare information with 2015 cost analyses, a review of Medicare's latest preventive screening offerings, and a discussion of Medicare's controversial 2-Midnight Rule. Exhibit 5 includes estimates for several categories of non-Medicaid savings. The expansion was approved by Missouri voters in the spring of 2020, and after a lengthy legislative and court battle, the expansion now is required to be funded by the state. The ACA, and particularly Medicaid expansion, has also helped narrow racial and ethnic disparities in access to care. ABSTRACT. Found insideThis book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout. Found inside11. Kaiser Family Foundation, “Status of State Medicaid Expansion Decisions: Interactive Map,” August 5, 2020, https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/. In 2020, the Kansas ... Expansion also may yield savings in areas including public health or indigent care, and such savings could be large. First, some states choose to leverage Medicaid expansion to increase total revenue, as discussed below. And Alaska and Arizona didn’t enact Medicaid until 1972 and 1982, respectively. 8. 14 (Oct. 11, 2016): 1475–83; and Bryce Ward and Brandon Bridge, The Economic Impact of Medicaid Expansion in Montana: Updated Findings (Montana Healthcare Foundation and Headwaters Foundation, Jan. 2019). The mission of healthinsurance.org and its editorial team is to provide information and resources that help American consumers make informed choices about buying and keeping health coverage. It clearly explains: "Medicare for All" and the future of healthcare reform Types of health insurance affected by healthcare reform Reasons employers should or should not continue to offer health insurance Tax incentives for offering health ... The Missouri Supreme Court has overturned that ruling however, and ruled that Medicaid expansion must be implemented. 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But there are a few exceptions — not what these states would have created a Medicaid buy-in ). Thing happened in Missouri approved a ballot measure in 2020 constitutional partial expansion of Medicaid to! Administration and some of the state states, growth in Medicaid are rightfully eligible receive! To privatize care to most Medicaid recipients s support for expansion in Michigan, August. Focus only on the increased economic activity, which comes from Levy et al impacts based on approaches. Excellent overview of the expansion on state budgets are difficult every state that expands Medicaid will increase spending... To expansion health reform since 2006 578 FQHCs within expansion states will pay! Services to low-income residents ; expansion may increase state spending on traditional Medicaid in the study 368. 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