A report from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured highlights the trends in Medicaid spending, enrollment, and policy initiatives for fiscal years (FY) 2013 and 2014. The findings of the report, drawn from the commission’s 13th annual budget survey of Medicaid officials in the 50 states and the District of Columbia, focuses on eligibility and enrollment changes related to: (1) the implementation of the Affordable Care Act (ACA); (2) payment and delivery system changes; (3) state and federal economic conditions; and (4) cost containment, program improvements, and program administration.
Present Coverage
The Commission reports that Medicaid provides health and long-term coverage to 66 million low-income Americans. According to the report, while one in six dollars of all health care spending in the United States is paid by Medicaid, Medicaid is the primary payer for long-term care services and supports (LTSS).
ACA Implementation
The role of Medicaid was broadened by the ACA to provide coverage for most Americans with incomes up to 138 percent of the federal poverty level (FPL). The Supreme Court’s ruling in National Federation of Independent Business v Sebelius, however, while maintaining the constitutionality of the ACA’s Medicaid expansion, effectively made the decision to implement the Medicaid expansion an option for states by limiting the authority of the Secretary of HHS to enforce it. While the Supreme Court’s decision limits enforcement of ACA’s Medicaid expansion, other Medicaid provisions of the ACA were not affected.
Survey Findings
The commission’s survey found that: (1) economic improvements have resulted in a 2.5 percent growth in Medicaid enrollment in 2013, the lowest growth rate in six years; (2) for FY 2014, however, enrollment is projected to rise by 8.8 percent as states implementing the Medicaid expansion will see higher enrollment due to participation by those newly eligible; (3) implementation of the ACA will result in changes to eligibility and enrollment to all states (regardless of whether the state is implementing the ACA expansion) due to the transition to the modified adjusted growth income (MAGI) eligibility standard, the transition of children with income above 100 and up to 138 percent of the FPL from the Children’s Health Insurance Program (CHIP) to Medicaid, and new streamlined application, enrollment, and renewal processes; (4) many states report a policy change to expand managed care, improve care through a managed care quality initiative, and the development of more sophisticated quality metrics and performance measures; and (5) more states have adopted increases or enhancements to provider payment rates or benefits than restrictions in FY 2013 and 2014.