The Children’s Health Insurance Program (CHIP) covers nearly nine million children and is a key contributor to record low levels of uninsurance among children. However, Congress only provided funding for CHIP through fiscal year (FY) 2017, which ended on September 30, 2017 and has not yet acted to authorize new funding for FY 2018. This Issue Brief reviews the current status of state CHIP programs in light of the CHIP funding extension delay and summarizes key features of proposed House and Senate extension legislation.
The brief provides an overview of the most recent changes to the Graham-Cassidy repeal and replace proposal and a just-released preliminary analysis of the proposal by the Congressional Budget Office (CBO). On September 13th, Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA)—along with Senators Dean Heller (R-NV) and Ron Johnson (R-WI) and former Senator Rick Santorum (R-PA)—released a new proposal to repeal and replace the Affordable Care Act (ACA). On September 25th, the sponsors released several updates to the proposed legislation. Also on September 25th, the CBO provided its preliminary analysis of one of the earlier versions of the bill.
This brief provides an overview of the proposal developed by Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) and filed on July 27th as a substitute for the American Health Care Act passed by the House to “repeal and replace” the Affordable Care Act (ACA). The proposal retains many features of the July 20th version of the Better Care Reconciliation Act (BCRA) released by Senate leadership (and rejected by the Senate on July 25th), including per capita caps on Medicaid spending and elimination of the individual and employer mandates.
State policy makers are increasingly focused on social determinants of health (SDOH) because of the important influence of these determinants on health care outcomes and Medicaid spending. This issue brief digs into opportunities that states have to account for SDOH in Medicaid programs.
The American Health Care Act (AHCA), as passed by the House of Representatives on May 4, 2016, would overhaul federal financing of state Medicaid programs, and for the first time, would cap federal Medicaid funding. As policymakers debate the potential implications of per capita caps, it has been suggested that per capita caps are really no different than Medicaid managed care—a concept with which states are fully familiar and well able to manage. This policy brief tests that hypothesis by examining the similarities and differences between the federal per capita cap and a state’s per capita “cap” in Medicaid managed care spending.
Medicaid’s unique and critical role in responding to events such as the opioid and HIV/AIDS epidemics, the 2001 World Trade Center attacks, the Flint, Michigan lead contamination crisis, and Hurricane Katrina are discussed in this brief.
Driven to improve care coordination and contain costs by moving away from a volume-based payment model, an increasing number of states are implementing risk-based managed care programs to deliver long-term services and supports (LTSS). As the primary payer for LTSS, state Medicaid programs have a significant interest in ensuring that entities with which they contract deliver high quality and cost-effective care to members. This issue brief identifies ways states can learn from value-based payment models being applied elsewhere to create more accountability for the quality and cost of LTSS.
American Indians and Alaska Natives could face a disproportionate impact in the event of ACA repeal. This report, authored by Dr. Donald Warne at North Dakota State University, in partnership with the National Indian Health Board, highlights the specific effects of ACA repeal.
Medicaid Expansion and Enhanced Match: How Proposals to Grandfather Medicaid Enrollees Could Impact States
Some federal proposals implement enrollment freezes for the Medicaid Expansion population, while grandfathering the enhanced match for enrollees that remain in the system. States have experiences with enrollment freezes in recent years and the changes in enrollment levels provide lessons for states moving forward. This issue brief, authored by the team at Manatt Health, highlights the experiences of three states and how enrollment freezes impact state Medicaid rolls.
While the focus of debate regarding repeal of the Affordable Care Act (ACA) has been on Marketplaces and the Medicaid expansion, myriad other provisions of the ACA are at risk of repeal—including those that streamline Medicaid eligibility and enrollment systems and implement a national, simplified standard for income eligibility. As of January 2016, 37 states are able to complete an eligibility determination in real time, defined as less than 24 hours, and among these, 11 states report that at least half of their applicants receive an eligibility determination in real time. The future of the ACA’s streamlined eligibility and enrollment-related provisions and the system improvements states have invested in to implement them are the subject of this issue brief.