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.
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.
Data Points to Consider When Assessing Proposals to Cap Federal Medicaid Funding: A Toolkit for States
Key leaders in Congress and high-ranking members of the Trump Administration are proposing major changes to Medicaid financing through the adoption of a block grant or per capita caps. To assist states in assessing the potential implications of proposals to cap federal Medicaid funding, the State Network team at Manatt Health has developed a toolkit providing state-by-state data on Medicaid enrollment and expenditure trends—factors that are central to establishing the amount each state would be allocated under various capped funding proposals.
Despite improvements that have been made over the past several decades, lead poisoning remains a serious hazard for many children in the U.S., presenting significant risks to their health and learning. More than 4 million families with children live in homes with high levels of lead, and approximately half a million under the age of five require treatment. The Children’s Health Insurance Program (CHIP) can provide critical financial support to states as they seek to implement cost-effective lead abatement activities to protect children.
Section 1115 waivers allow states to waive certain Medicaid statutory requirements in order to advance state policy priorities and test innovations in their Medicaid programs, provided that they are budget neutral and “further the goals of the Medicaid program.” Since 2014, seven states have used 1115 waivers to implement alternative Medicaid expansions, and these waivers are likely to be leveraged by states in the next four years to advance changes to Medicaid. This issue brief, developed by Manatt Health, provides an overview of the features of these alternative Medicaid expansion waivers.
Shared Measurement and Joint Accountability Across Health Care and Non-Health Care Sectors: State Opportunities to Address Population Health Goals
Health care leaders are well-positioned to use cross-sector approaches to drive improvements in population health in collaboration with state leaders. Through the use of joint measurement and accountability tools, policymakers can help to improve health outcomes to an extent not possible through isolated, medical-centric efforts. This issue brief, developed by Dana Hargunani, MD, MPH, outlines how state agencies can use shared measurement and joint accountability across sectors as tools for improving population health outcomes.
Proposals for the incoming Congress and presidential administration to repeal the Affordable Care Act (ACA) have also included a call for a fundamental overhaul of the Medicaid program by imposing caps on federal funding to states. Such capped funding would replace the central feature of Medicaid’s financing structure, the federal government’s legal obligation to share all allowable state Medicaid costs. While the design of various proposals to cap federal Medicaid funding may differ in several ways, they all aim to allow the federal government to achieve budget certainty and reduce federal Medicaid spending.