Medicaid provides health coverage for low-income children and adults, medical and long-term care coverage for people with disabilities, and assistance with health and long-term care expenses for low-income seniors. More than 58 million people rely on Medicaid services today, and millions more will qualify for Medicaid when the provisions of the Affordable Care Act take effect in 2014.
Children receive health coverage through Medicaid and the state Children’s Health Insurance Program (CHIP). To learn more about CHIP, see the Children’s Health section.
This section of our website provides resources on Medicaid laws and regulations and keeps you up-to-date on the battle to sustain and improve this important program.
Medicaid Expansion Center
States that plan to expand Medicaid coverage in 2014 have much to do to prepare. In many states, advocates need support in making the case for expansion. The Medicaid Expansion Center offers information on everything from the Supreme Court decision’s effect on Medicaid to news from the Department of Health and Human Services (HHS), plus the best tools for helping your state make the most of the expansion.
Medicaid Defense Center
While some states move ahead to expand their Medicaid programs, the existing Medicaid program remains under fire at both the federal and state level. Many in Congress—and some governors, as well—seek to make deep cuts in Medicaid funding and to change the structure of the Medicaid program through proposals for block grants, per capita caps, and similar schemes. The Medicaid Defense Center features the latest news on the federal budget battle plus tools to help you fight for Medicaid funding in your state.
New final regulation: On July 5, 2013 the Center for Medicare and Medicaid Services issued final regulations covering a number of Exchange eligibility, Medicaid, and CHIP provisions contained in a January 22 Notice of Proposed Rulemaking. Among items addressed in the final rule are Medicaid cost sharing; design of Alternative Benefit Plans; employer coverage and income verification for premium tax credits; and requirements for premium assistance programs. Items in the proposed rule that are not covered will be addressed in future regulations.
Arkansas legislature passes Medicaid premium assistance legislation: On April 17th, the Arkansas legislature passed a bill to allow Arkansas to use private exchange plans to expand Medicaid in 2014. The governor will sign the bill. Arkansas is the first state to approve this approach to Medicaid expansion, called premium assistance. The Arkansas expansion plan still needs approval from CMS.
CMS issues FAQs on Premium Assistance: Several states have expressed interest in expanding Medicaid by purchasing policies through exchange plans, rather than providing coverage through the traditional Medicaid program. On March 29, CMS issues a series of FAQs on the different ways states could pursue this option, called premium assistance, and the types of proposals that they would consider.
2013 Federal Poverty Guidelines are now available from HHS, and Families USA has calculated the figures for various household sizes by percentage of the federal poverty level.
New Final Regulations: On February 21, 2013, the Department of Health and Human Services (HHS) released its final regulations on the essential health benefits standard, which is important for the Medicaid expansion. When states develop their alternative benefit plans for people who will be covered through the Medicaid expansion, those plans must include the essential Health benefits. For more information about alternative benefit plans and how they relate to essential health benefits, see the letter to state Medicaid directors from November 20, 2012.
FAQs: On December 10, 2012, the Centers for Medicare and Medicaid Services (CMS) issued a document that answered frequently asked questions regarding exchanges, insurance market reform, and Medicaid. The discussion regarding the Medicaid expansion begins at question 24.
From Families USA:
Medicaid Alternative Benefit Plans: What They Are, What They Cover, and State Choices explains how states can design Alternative Benefit Plans to meet the health care needs of the Medicaid expansion population. (September 2013)
Continuous Eligibility Can Prevent Disruptions in Health Coverage for Children explores how states can combat "churning," or disruptions in coverage, by implementing 12-month continuous eligibility policies. (August 2013)
Accountable Care Organizations (ACOs) in Medicaid: Challenges and Opportunities for Advocates discusses why states may want to develop Medicaid ACOs and how to implement them. It also lays out challenges and questions advocates should consider if their states move forward. (June 2013)
Expanding Medicaid Using Premium Assistance, or the "Private Option," to Buy Health Insurance, explains to advocates what premium assistance is, how it can be used to expand Medicaid, and how to get involved if their state is considering this approach. (June 2013)
The Managed Fee-for-Service Option To Integrate Care for Dual Eligibles: A Guide for State Advocates examines the option to integrate care for dual eligibles that does not rely on private managed care companies. It looks at the strengths and weaknesses of the model and how advocates can engage with state and federal policy makers to ensure that beneficiaries’ interests are protected as these demonstrations move forward. (May 2013)
The Promise of Care Coordination: Transforming Health Care Delivery discusses care coordination as an opportunity for health system reform that is based on the needs of patients. It explains what advocates need to know to ensure that their state's care coordination programs stay focused on improving care quality and patient health. (April 2013)
Holding Health Homes Accountable for High-Quality Care: Payment and Quality Measures describes options for paying Health Home providers and measuring quality. It explains how advocates can identify and promote the best policies for consumers, and it includes examples from the following states: IA, MO, NY, NC, OH, OR, and RI. (February 2013)
The January 2013 Budget Deal: The American Taxpayer Relief Act and Medicaid explains how the law that was signed on New Year's Day to avert the fiscal cliff affects Medicaid and other programs for low-income people. (February 2013)
The 2013 New Year's Budget Deal and Medicaid: The Next Cliff explains how the deal that averted the fiscal cliff affects Medicaid. It also discusses additional upcoming threats to Medicaid and what advocates can do to protect the program. (January 2013)
Designing Consumer-Friendly Health Homes discusses six key decisions that states need to make when they set up Health Homes. It also explains the challenges that state advocates should address to ensure that Health Homes improve care for Medicaid beneficiaries. (January 2013)
State Advocate To-Do List for 2013 outlines issues that advocates may want to address in 2013 in anticipation of the changing health care environment. (January 2013)
From the Center on Budget and Policy Priorities:
Online Services for Key Low-Income Benefit Programs describes the information and services that states make available online for programs such as the Children’s Health Insurance Program (CHIP) and Medicaid. It includes a chart that shows which states offer online applications and a list of links to information about low-income programs in each state. (January 2013)
From the Kaiser Commission on Medicaid and the Uninsured:
Medicaid's Role in Meeting the Long-Term Care Needs of America's Seniors examines Medicaid's role as the nation's primary payer of long-term services and supports. It includes state-level data on Medicaid enrollment and expenditures for elderly beneficiaries. (February 2013)
Getting into Gear for 2014: Findings from a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2012-2013 provides a snapshot of current state policies and procedures, and it highlights the changes that states will need to make to prepare for full implementation of the Affordable Care Act in 2014. (January 2013)
Implementation of Affordable Care Act Provisions to Improve Nursing Home Transparency, Care Quality, and Abuse Prevention describes the new requirements that were included in the Affordable Care Act for nursing homes that participate in Medicare and Medicaid. It also explains the reasons for incorporating these requirements into the law and the progress that has been made in implementing them so far. (January 2013)
Medicaid Home and Community-Based Services Programs: 2009 Data Update summarizes the key trends in expenditures and participation in the three main Medicaid home and community-based services programs. It also highlights results from a 2011 survey on provider reimbursement policies and participant eligibility and enrollment. (December 2012)
From the National Women’s Law Center:
Job Loss: The Hidden Cost of Medicaid Cuts to Women analyzes the importance of Medicaid for women’s employment in the health sector. It includes state-level data on the number of Medicaid-supported health sector jobs that are held by women. (December 2012)
From the Pew Charitable Trusts:
Infographic: How Many People Would Medicaid Expansion Cover? illustrates the percentage of adults in each state that would be affected by the Medicaid expansion, and it indicates which states will expand and which states are still undecided. (January 2013)
From the Robert Wood Johnson Foundation and the Urban Institute:
Medicaid/CHIP Participation among Children and Parents finds that eligibility for and participation in Medicaid and the Children’s Health Insurance Program (CHIP) increased for children from 2008 to 2010, but participation among adults remained low. It includes state-level data on participation rates. (December 2012)
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