Medicaid Expansion: Framing and Planning a Financial Impact Analysis
Manatt Health Solutions; Center for Health Care Strategies; State Health Access Data Assistance Center
Introduction & Overview
This worksheet and considerations table can serve as a guide for states considering their own Medicaid expansion analysis. The Supreme Court’s decision inNFIB v. Sebelius did not change the underlying Medicaid expansion provisions of the Affordable Care Act (ACA), but did remove the ACA’s enforcement authority for states choosing not to expand. As a result, states are facing an unexpected and difficult implementation decision regarding this expansion. The availability of 100 percent federal match for this population from 2014 through 2016, along with federal match ratcheting down to 90 percent in the later years, is, for many states, a strong incentive to expand Medicaid. Regardless of that incentive, most states are taking a measured and analytical approach to determining the fiscal impact of this choice before making a final decision.
Created by State Network experts at the State Health Access Data Assistance Center (SHADAC), Center for Health Care Strategies (CHCS), and Manatt Health Solutions, this analysis approach is limited to financial considerations related to the state’s decision to expand and therefore excludes many important financial aspects related to the ACA as a whole (e.g. remaining mandatory provisions). State specific Medicaid expansion analysis should take into account existing program structure, available data sources (both state and national) and realistic assumptions about enrollment and costs. States should also note within the analysis whether costs are directly related to the Medicaid expansion or if they are likely to occur despite expansion (e.g., the woodwork effect for individuals eligible but not currently enrolled).
Medicaid enrollment has increased by over 10 million (or 15 percent) from February 2020 through February 2021 across all states since the outbreak of the COVID-19 pandemic. States have a clear imperative to center health equity as they plan for the end of the public health emergency (PHE) given that Black, Latino/a, and other people of color are most at risk of coverage loss. This expert perspective highlights strategies states can implement to ensure that the end of the PHE does not exacerbate already widespread racial and ethnic disparities in our health care system.
COVID-19 vaccines are now widely accessible in the United States and free to everyone over the age of 12. Given the spread of the Delta variant, there is an urgent need to increase vaccination rates, particularly among Medicaid enrollees. States across the country continue to report Medicaid enrollees are getting vaccinated at lower rates than the general population. This expert perspective explores how state Medicaid managed care programs and health plans can work collaboratively to increase COVID-19 vaccination rates for the more than 55 million Medicaid enrollees in comprehensive managed care plans.
Many states are looking to fill gaps in race and ethnicity data for Medicaid and related agencies. Working with the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota, with support from the State Health and Value Strategies (SHVS) program, New York tested multiple strategies aimed at encouraging applicants to answer the optional race and ethnicity questions. This expert perspective highlights an effort by New York’s official state-based marketplace, NY State of Health, to improve the completeness of race and ethnicity data that applicants share when applying for Medicaid; Child Health Plus, the state’s Children’s Health Insurance Program (CHIP); the Essential Plan, New York’s Basic Health Program (BHP); or Qualified Health Plan (QHP) coverage through its Marketplace.