Georgians for a Healthy Futures 2015 Health Care Unscrambled Breakfast Joan Alker Executive Director Georgetown University Center for Children and Families Atlanta Georgia January 15 2015 ID: 513681
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Medicaid Expansion: Where are Red States Going?Georgians for a Healthy Future’s2015 Health Care Unscrambled Breakfast
Joan AlkerExecutive DirectorGeorgetown University Center for Children and FamiliesAtlanta, GeorgiaJanuary 15, 2015Slide2
Source: Health Insurance Policy Simulation Model 2012 from “What is the Result of State Not Expanding Medicaid?” Urban Institute, August 2014.
2Slide3
Why Covering Parents is Key for KidsEnhances the financial security of the familyImproves the health of the parentMaternal depression concrete example of benefitsReduces the # of uninsured kids too!
MA health reform resulted in 50% reduction in uninsured kids – most uninsured kids (68%) are eligible for Medicaid/CHIP but not enrolled3Slide4
Source: State decisions on the Medicaid expansion as of December 15, 2014. Based on state legislative scan by Georgetown CCF.
Status of Medicaid Expansions
WY
WI
WV
WA
VA
VT
UT
TX
TN
SD
SC
RI
PA
OR
OK
OH
ND
NC
NY
NM
NJ
NH
NV
NE
MT
MO
MS
MN
MI
MA
MD
ME
LA
KY
KS
IA
IN
IL
ID
HI
GA
FL
DC
DE
CT
CO
CA
AR
AZ
AK
AL
Moving Forward at this Time (24 States including DC)
Moving Forward with a Section 1115 Waiver (4 States)
Section 1115 proposal submitted to Federal Government (
1
State)
Governors with Section 1115 proposals that require legislative approval (3 States)
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How are States Thinking about Medicaid Expansion?Most states (24) implementing the Medicaid expansion through a State Plan Amendment (SPA) using flexibility provided in the law
States have more flexibility than they thinkLimited number of states are seeking waivers for alternative approaches to implement the ACA (4 states approved,1 pending, 3 in formation )Will most states go the waiver route in the future?Source: The Kaiser Commission on Medicaid and the Uninsured 5Slide6
What is a Section 1115 waiver?1115 Waiver authority is for demonstrations that promote the objectives of the Medicaid programAuthorizes the HHS Secretary to waive certain federal Medicaid requirements and provide federal funds for costs that would not otherwise be matched Section 1115 waivers are required to be budget neutral to the federal government
Waiver approval involves negotiations between state and HHSThe ACA requires transparency and meaningful opportunities for public input in the 1115 waiver process6Slide7
What Role Do Waivers Play in Medicaid Policy?Long history of being used to drive changes
Popular to show your bona fides esp. if a Republican GovernorVery opaque process which is now slightly better due to ACA transparency rulesThere are certain parts of the statute that cannot be waivedFMAP7Slide8
Key Themes that are EmergingPremiums and cost-sharing in all kinds of new forms for adultsUsing private insurance or premium assistance – very sweeping change possible for kids eventuallyRequiring work or job trainingPromoting “healthy behaviors” and “personal responsibility”
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Key Themes have Emerged in Alternative Approaches to the Medicaid ExpansionSource: The Kaiser Commission on Medicaid and the Uninsured
9Premium AssistancePremiums
Health Behavior Incentives
Benefit Changes
Work Search
Health Saving Accounts
Arkansas (approved)
x
x
Iowa (approved)
x
x
x
x
Michigan (approved)xxPennsylvania(approved)x
xxxxIndiana(proposed)xxxxxxTennessee(proposed)x
xxxSlide10
How has Obama Administration Reacted?Trying to thread the needle; not overly politicalHave drawn some mostly clear linesNo partial expansion at full match (WI)
No premiums below poverty tied to eligibilityLimits on cost-sharing (using existing flexibility)Benefits except transportationWraparound benefitsAll of this is contributing to complexity 10Slide11
For More InformationJoan Alker:jca25@georgetown.eduTwitter
@JoanAlker1CCF website: ccf.georgetown.eduTwitter @GeorgetownCCFSay Ahhh! Our child health policy blog: ccf.georgetown.edu/blog/ 11