Medicaid Expansion Positively Impacts State Finances, Analysis Finds

A Kaiser Family Foundation analysis of more than five dozen studies found positive effects of Medicaid expansion on multiple state economic outcomes, and a reduction in income- and race-based coverage disparities. Specifically, the report found that general fund spending on Medicaid grew more slowly in expansion states compared to non-expansion states and that spending per capita is at or below projections in nearly two-thirds of expansion states, despite higher-than-anticipated expansion enrollment in many states. The studies also found reduced uncompensated care costs in expansion states, and most found that expansion had either a positive or a neutral effect on employment and labor markets. The authors note that additional research will be needed to assess expansion's economic impacts once states begin paying a larger share of expansion costs. The analysis also found largely positive impacts of expansion on uninsurance rates, access to care, utilization of services, and health outcomes, though the report concludes that long-term research is needed to better determine expansion's impact on health outcomes.

Care Is More Affordable and Accessible for Medicaid Expansion Enrollees, Report Finds

Medicaid expansion has increased access to primary care and prescription drugs and made care more affordable for enrollees, according to a report from the Assistant Secretary of Planning and Evaluation at HHS. Research cited in the report found that visits to community health centers increased 46% in expansion states compared to 12% in non-expansion states, and that there was a 41% increase specifically in preventive visits in expansion states while non-expansion states saw no change. Expansion states also saw a 50% decrease in uninsured hospital discharges in addition to a 20% increase in Medicaid discharges. In 2014, Medicaid prescription rates increased 25% in expansion states compared to 3% in non-expansion states. On affordability measures, the report cites a survey that found 78% of expansion enrollees would not have been able to afford their care prior to enrolling in Medicaid expansion. The report also reviews expansion's impact on uninsurance rates and found that expansion states cut their uninsured rates in half while non-expansion states cut their rates by one-third.

CMS Clarifies Public Notice and Input Requirements for Changes to Provider Payments

CMS issued an informational bulletin clarifying public notice and input requirements that states must follow when changing provider payments under a Medicaid State Plan. The bulletin addresses in detail three types of public notice policies: all proposed changes to provider payment rates or methodologies; reduced or restructured payments that may impact access to care; and institutional provider rates. The bulletin permits states to use a single mechanism to meet all requirements under certain circumstances, including that the public is notified of changes prior to the effective date, that parties interested in institutional rates have a reasonable opportunity for review and comment, and that stakeholders have a chance to provide input on the impact of payment changes as it relates to access to care prior to submission to CMS. Requirements addressed in the bulletin were either longstanding or recently codified in CMS' final rule, "Methods for Assuring Access to Covered Medicaid Services," finalized in November 2015.

CMS Provides Guidance for States Seeking Enhanced Funding for Medicaid Eligibility and Enrollment Systems

A CMS State Medicaid Directors (SMD) letter clarifies how states can demonstrate their compliance with the conditions and standards necessary to receive enhanced funding for eligibility and enrollment systems, first detailed in a December 2015 rule. The SMD letter, which reviews new Advanced Planning Document (APD) requirements, is the second in a series addressing subject areas affected by the rule. The letter highlights that, among other new conditions, states must demonstrate in their APDs their ability to process Medicaid applications based on modified adjusted gross income with minimal mitigations or workarounds, and they must submit mitigation plans and strategies to address potential risks or system failures. CMS indicated it may establish additional new conditions in future SMD letters.