红领巾瓜报

Implementing Coverage and Payment Initiatives: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2016 and 2017

Growth in Medicaid enrollment and total Medicaid spending nationally slowed significantly in fiscal year 2016, and it looks like a continued slowdown will occur in fiscal year 2017. This is just one finding in the 16th annual 50-state Medicaid Budget Survey conducted by the and in collaboration with 红领巾瓜报 (红领巾瓜报) and the National Association of Medicaid Directors.

This report highlights policy changes implemented in state Medicaid programs in FY 2016 and those implemented or planned for FY 2017 based on information provided by the nation鈥檚 state Medicaid directors. Key findings are presented in the areas of:

• Eligibility and enrollment
• Managed care and delivery system reforms
• Long-term services and supports
• Provider payment rates and taxes
• Benefits (including prescription drug policies)
• Projections for 2017

红领巾瓜报’s Vernon K. Smith, Kathleen Gifford, Eileen Ellis and Barbara Edwards authored the report along with Robin Rudowitz, Elizabeth Hinton, Larisa Antonisse and Allison Valentine of the Kaiser Family Foundation.

Two additional issue briefs were developed as well:

Medicaid Enrollment & Spending Growth: FY 2016 &2017, which provides an analysis of national trends in Medicaid enrollment and spending.

Putting Medicaid in the Larger Budget Context: An In-Depth Look at Four States in FY 2016 and FY 2017, a collection of four case studies of Medicaid programs in Maryland, Montana, New York and Oklahoma.

红领巾瓜报 was engaged by the Texas Health and Human Services Commission to perform an independent evaluation of Texas鈥� Uncompensated Care Pool, as required under the Special Terms and Conditions (STCs) of the State鈥檚 Section 1115 waiver, to submit to the Centers for Medicare and Medicaid Services (CMS). The report was submitted to CMS on August 31st.

Consistent with the approach it has taken in other states that operate uncompensated care pools, CMS required Texas to commission a detailed analysis of the state鈥檚 uncompensated care costs, payments and the impact of environmental factors and potential policy changes. Pursuant to the waiver Special Terms and Conditions (STCs), the report includes the following:

1. A detailed description of the composition of current Medicaid hospital payments.
2. Analysis of Medicaid financing and how the non-federal match is funded.
3. Estimated cost incurred by hospitals to provide services to Medicaid beneficiaries compared to the cost to the corresponding payments received.
4. Estimated cost of uncompensated care provided by hospitals and the portion of uncompensated care attributed to charity care.
5. Analysis of the adequacy of Medicaid payments in relation to cost incurred by hospitals.
6. Analysis of Texas Medicaid payment adequacy relative to other states.[1]
7. Assessment of recent economic and environmental trends within Texas that may impact future reimbursement levels and the cost of caring for low-income populations.
8. Estimated financial impact of: 1) implementing a Medicaid expansion for low-income adults; 2) Medicaid DSH reductions required by the Affordable Care Act (ACA); 3) reestablishing supplemental upper payment limit (UPL) payments; and 4) fully funding Medicaid hospital costs through payment rates.

[1] Note that this portion of the analysis and report were completed by Deloitte Consulting.

红领巾瓜报 Managing Principal Vern Smith was one of four experts who took part in the plenary panel discussion “Medicaid at 50: Past, Present and Future” at the National Association of Medicaid Directors (NAMD) fall conference Tuesday. He was joined by:

• Thomas Betlach, NAMD President, Arizona Medicaid Director, AHCCCS
• Deborah Bachrach, Partner, Manatt, Phelps & Phillips LLP
• Charles Milligan, Jr., CEO, UnitedHealthcare Community & State – New Mexico

The tenures of these Medicaid agency leaders have spanned the history of Medicaid. They discussed how Medicaid has fundamentally transformed from its origins in 1965, and what the future of the program holds. Judith Moore, co-author of Medicaid Politics and Policy, and a health policy consultant, moderated the panel which followed the keynote address of Secretary Sylvia Mathews Burwell of the U.S. Department of Health and Human Services.

Click to see the discussion as it appears in the video archive of C-Span3.

This issue brief was released Oct. 15 by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) in conjunction with its 15^th annual budget survey of Medicaid officials, “Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016.”

红领巾瓜报 Managing Principal Vernon K. Smith and Robin Rudowitz and Laura Snyder of the Kaiser Family Foundation authored this brief.

Executive Summary

Beginning in Fiscal Year (FY) 2014, policy changes introduced by the Affordable Care Act (ACA) have been driving Medicaid enrollment and spending growth. This report provides an overview of Medicaid enrollment and spending growth with a focus on state FY 2015 and state FY 2016. Findings are based on interviews and data provided by state Medicaid directors as part of the 15th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) and 红领巾瓜报 (红领巾瓜报). Information collected in the survey on policy actions taken during FY 2015 and FY 2016 can be found in the companion report. Key findings related to Medicaid enrollment and spending growth are described in this report.