In the absence of federal legislation, states are actively seeking tools to reform their health care systems. While 1115 waivers rightly get a lot of attention, because of their ability to reshape state Medicaid programs, the Affordable Care Act’s Section 1332 waivers continue to be a promising avenue for states to stabilize their health insurance marketplace. SHVS is tracking state activity and has many resources, including a template, for states interested in pursuing a Section 1332 waiver.
Medicaid at a Crossroads: What’s at Stake for the Nation’s Largest Health Insurer
Deborah Bachrach, Patricia Boozang, and Arielle Traub, Manatt Health
Since its inception 50 years ago, Medicaid has evolved from a small welfare program into an integral part of the nation’s health insurance system, now covering more than one in five low-income children and adults. As Medicaid coverage has expanded and stabilized, states are making strides to improve the cost and quality of the care provided to Medicaid enrollees. Because Medicaid is the single largest payer in every state, governors are using Medicaid to drive multi-payer reforms, including adoption of value-based payment methodologies and advancement of population health models. Proposals being considered by Congress and the new administration to repeal the Affordable Care Act’s (ACA) Medicaid expansion and implement limits on federal Medicaid funding through block grants and per capita caps could have a significant impact on these advances. This issue brief, developed by Manatt Health, considers how much states have accomplished to drive value in and through their Medicaid programs over the last 50 years, and most especially over the last five years, and what states stand to lose in terms of progress and innovation in their Medicaid programs and health care delivery systems if federal support for Medicaid is reduced.