Only 7 states, D.C. expand Medicaid ahead of 2014

But most states have made progress on at least one of five options to improve their Medicaid programs authorized by the health reform law.

By — Posted June 11, 2012

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Most states have taken advantage of new health system reform law provisions to upgrade or improve care within their Medicaid programs, but only seven and the District of Columbia so far have sought an option to cover more adults before the 2014 expansion of the program, according to a recent Kaiser Commission on Medicaid and the Uninsured policy brief.

One of the chief goals of the reform law was to expand Medicaid to nearly all individuals with incomes up to 133% of the federal poverty level to help decrease the number of uninsured. The law provided states with an option to receive additional federal Medicaid matching funds to get an early start on this expansion.

States already providing some optional coverage to low-income adults through solely state- or county-funded programs were the ones most likely to take advantage of this option, said Robin Rudowitz, an associate director with the Kaiser Commission on Medicaid and the Uninsured. “It was fiscally advantageous for those states to move forward quickly, because they were able to then access Medicaid financing for this coverage.”

Besides the District of Columbia, states expanding Medicaid early are California, Colorado, Connecticut, Minnesota, Missouri, New Jersey and Washington.

An expansion of such coverage ultimately means that more Medicaid beneficiaries will be seeking treatment in doctors’ offices. “All physicians are going to be torn between their altrusitic perspective that everyone should have access to basic health coverage” and the fact that Medicaid payments don’t always cover doctors’ costs of providing that care, said Glen Stream, MD, president of the American Academy of Family Physicians.

Dr. Stream said this underscores the need to make the reform law’s Medicaid parity provision, which will set Medicaid primary care payments for selected physicians at Medicare rates for the next two years, into a permanent program.

Since April 2010, the states that have received approval to expand Medicaid to additional low-income adults have done it through the new reform law option and/or through the federal Section 1115 waiver process.

Other states are still dealing with the ramifications of the latest economic recession, “so we haven’t seen outside of this provision such large eligibility expansions in the last few years because states have had such dire fiscal constraints,” Rudowitz said. Still, even many of those states have pursued new options to simplify or streamline their application or enrollment processes for Medicaid, she added.

Forty-three states and the District of Columbia have made progress on at least one of five options to improve their Medicaid programs under the Patient Protection and Affordable Care Act. “Most state participation to date has been to make upgrades to Medicaid eligibility systems (28 states and D.C.), and has included states in varied states of preparing for the ACA coverage expansions,” the policy brief stated. Twenty-six states have submitted proposals to test integrated care models for beneficiaries eligible for both Medicare and Medicaid, and 10 have received five-year grant funding to help prevent chronic diseases.

Rudowitz noted that the Kaiser policy brief doesn’t reflect the entirety of what states are doing to revise their Medicaid programs.

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States acting early on new Medicaid options

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Only seven states — California, Colorado, Connecticut, Minnesota, Missouri, New Jersey and Washington — and the District of Columbia have started offering Medicaid to additional adults ahead of the 2014 expansion of the program. But most states have pursued at least one of the other options offered by the national health system reform law to improve Medicaid, which are upgrading eligibility systems, dedicating funding to disease prevention, moving forward on establishing health homes, and integrating or aligning care for Medicare-Medicaid dual eligibles.

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External links

“How is the Affordable Care Act Leading to Changes in Medicaid Today? State Adoption of Five New Options,” Kaiser Commission on Medicaid and the Uninsured, May 18 (link)

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