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).
In this new expert perspective series, State Health and Value Strategies will highlight examples of the work states are engaging in to prepare for and operationalize the unwinding of the continuous coverage requirement to minimize coverage losses. This new series aims to showcase strategies that other states may be interested in adopting and highlight how states are leveraging federal flexibilities.
The unwinding of the Medicaid continuous coverage requirement represents the largest nationwide coverage transition since the Affordable Care Act, with significant health equity implications. Given the intense focus on coverage transitions during the unwinding, some states have initiated plans to publish a data dashboard to monitor progress. To date, five states—Iowa, Minnesota, Utah, Washington, and West Virginia—have publicly released some type of unwinding data (this includes states reporting unwinding data in both a dashboard and a static format, but not states with pre-existing enrollment dashboards that don’t specifically identify unwinding cohorts). SHADAC will update this expert perspective as additional dashboards go live.
To maximize efforts to maintain coverage, state Medicaid agencies and Marketplaces can now leverage digital channels as part of their overall outreach and communications efforts. Rapidly evolving changes in consumer media consumption habits as well as shifts in digital channels, and the ability to leverage data sources, enables granular audience targeting and efficient use of resources. These can be incorporated into an overall integrated outreach and education campaign to maximize renewals and coverage retention.