Assessing the Fiscal Impact of Medicaid Expansion Following the Enactment of the American Rescue Plan Act of 2021
A substantial body of evidence indicates that adopting the Medicaid expansion delivers myriad benefits to states and Medicaid enrollees at a modest cost to states. Currently, 12 states have not yet taken up the ACA Medicaid expansion, leaving approximately 2.2 million adults in the so-called “coverage gap” without an affordable source of coverage. The recent enactment of the American Rescue Plan Act of 2021 (ARP) makes the fiscal case for Medicaid expansion even stronger by providing states that implement expansion after the enactment of ARP with a significant increase in Medicaid funding. This issue brief describes the ARP matching rate provision and also assesses its fiscal impact for each of the states that have not yet expanded Medicaid, while comparing the available new federal dollars to the cost of expansion.
The Internal Revenue Service (IRS) has now released more information about how consumers can receive relief from repayment of excess advance premium tax credits for 2020 under the American Rescue Plan. The information is directly relevant to many 2020 marketplace consumers. While this provision will have a positive impact on marketplace consumers, it could also create confusion given the timing and will require some quick communications. Several state-based marketplaces (SBMs) have expressed interest in language that can be used to provide consumers with information about this new tax relief. State Health and Value Strategies has developed the following template language that SBMs can adapt and use in consumer-facing communications.
On March 11, President Biden signed an approximately $1.9 trillion COVID-19 relief bill—the American Rescue Plan Act of 2021 (“the American Rescue Plan,” ARPA). The American Rescue Plan includes myriad health care provisions, focused primarily in two areas: first, it provides funding the Biden administration requested to carry out its COVID-19 response plans; second, it enacts significant but largely temporary coverage policies. Although all health care coverage provisions of the bill are temporary, many will have a lasting impact. This timeline provides the start and end dates for key health care provisions to help states plan for implementation and future policymaking.
On Tuesday, March 23, State Health and Value Strategies hosted a webinar to discuss how to best communicate with consumers and other stakeholders so residents can take full advantage of new financial help through the Marketplace, free COBRA plans, and more provided by the American Rescue Plan. The webinar was the third in a series that SHVS is hosting on the American Rescue Plan Act of 2021. Experts from GMMB walked through key questions to consider, thoughts on audience segmentation, initial messaging and potential outreach tactics. We also heard from states on their real-time communication plans for rollout.
On Tuesday, March 16, State Health and Value Strategies hosted the second of three webinars to address key provisions of the American Rescue Plan Act of 2021. The $1.9 trillion budget reconciliation package was signed into law by President Biden on March 11. The legislation is wide-ranging, seeking to support Americans as we continue to recover from the fallout of the COVID-19 pandemic and economic downturn. This second webinar, with experts from Manatt Health, reviewed key Medicaid provisions and state/local relief funding included in the COVID-19 relief package. Presenters also discussed considerations for state policymakers as they look to implement the American Rescue Plan, and how some proposals that did not end up in the final legislation could foreshadow future policy priorities.
On Friday, March 12, State Health and Value Strategies hosted the first of three webinars to address key provisions of the American Rescue Plan Act of 2021. The $1.9 trillion budget reconciliation package was signed into law by President Biden on March 11. The bill is wide-ranging, seeking to support Americans as we continue to recover from the fallout of the COVID-19 pandemic and economic downturn. The first webinar explored changes to private insurance, including Marketplaces. Tax expert Jason Levitis and Joel Ario from Manatt Health explored the premium tax credit changes and COBRA subsidy and outlined decision points for state policymakers and consumers.
The Tracking Medicaid Enrollment Growth During COVID-19 Databook provides a comprehensive, detailed look at Medicaid enrollment trends to-date. Using Medicaid enrollment data from over 40 states, the Databook provides a comprehensive, detailed look at Medicaid enrollment trends from the beginning of the COVID-19 pandemic through January 2021. The Databook provides enrollment detail by state across four eligibility categories: expansion adults, children (including those enrolled in CHIP), non-expansion adults, and aged, blind, and disabled individuals. It also compares enrollment trends across expansion and non-expansion states. The Databook has been updated through January, 2021.
This document provides excerpts of health disparities and health equity contract language from Medicaid managed care (MMC) contracts from 12 states and the District of Columbia as well as the contract for California’s state-based marketplace, Covered California. The criteria for inclusion in this compendium were contracts that explicitly addressed health disparities and/or health equity. Website links to the full contracts are included where available.
On Wednesday, February 24, State Health and Value Strategies hosted a webinar on analyzing health disparities in Medicaid managed care. Health disparities are a key indicator of health equity and understanding health care disparities is a critical component of informing systems changes to improve health care outcomes. Stratifying performance data by race, ethnicity, disability, gender identity, or sexual orientation can inform targeted interventions to reduce health care disparities; yet many states lack complete and reliable data to do so. During the webinar, experts from Bailit Health discussed how states can use performance rates and disparities analyses from Medicaid managed care programs in other states to determine where disparities are likely to exist in their own state and develop interventions.
Many states are experiencing budget shortfalls due to the COVID-19 induced recession. Since Medicaid accounts for a significant portion of states’ budgets, states often look to the Medicaid program for savings. Since the Great Recession, states have invested in initiatives that can improve care and also lower costs—such as improving coordination of behavioral health and physical health services, making home and community-based options more available to those who might otherwise go into nursing homes, addressing social drivers of health, and lowering pharmacy costs. Not all of these initiatives can generate short-term savings, but they offer other actions that states facing budget shortfalls may take to achieve savings. This toolkit outlines state options to address Medicaid spending without harming enrollee health and provider stability and access to care.