Medicaid Expansion: Framing and Planning a Financial Impact Analysis
Manatt Health Solutions; Center for Health Care Strategies; State Health Access Data Assistance Center
Introduction & Overview
This worksheet and considerations table can serve as a guide for states considering their own Medicaid expansion analysis. The Supreme Court’s decision inNFIB v. Sebelius did not change the underlying Medicaid expansion provisions of the Affordable Care Act (ACA), but did remove the ACA’s enforcement authority for states choosing not to expand. As a result, states are facing an unexpected and difficult implementation decision regarding this expansion. The availability of 100 percent federal match for this population from 2014 through 2016, along with federal match ratcheting down to 90 percent in the later years, is, for many states, a strong incentive to expand Medicaid. Regardless of that incentive, most states are taking a measured and analytical approach to determining the fiscal impact of this choice before making a final decision.
Created by State Network experts at the State Health Access Data Assistance Center (SHADAC), Center for Health Care Strategies (CHCS), and Manatt Health Solutions, this analysis approach is limited to financial considerations related to the state’s decision to expand and therefore excludes many important financial aspects related to the ACA as a whole (e.g. remaining mandatory provisions). State specific Medicaid expansion analysis should take into account existing program structure, available data sources (both state and national) and realistic assumptions about enrollment and costs. States should also note within the analysis whether costs are directly related to the Medicaid expansion or if they are likely to occur despite expansion (e.g., the woodwork effect for individuals eligible but not currently enrolled).
In February, Galen Benshoof underscored the importance of agents and brokers in ensuring robust enrollment and exchange sustainability. Recognizing this, the State Network funded programs in Illinois and Minnesota, led by Wakely Consulting Group (Wakely), to enhance in-person agent and broker engagement while expanding their capability to assist anyone who walks through their doors, even if they are eligible for Medicaid or other state coverage programs. These Lead Broker Agency programs were a success, and the states are planning to continue or expand the programs next year!
A new issue brief, prepared by Kathie Mazza at Wakely and available here, describes the concept of these pilots and outlines how other states interested in partnering with insurance brokers can implement similar initiatives for future open enrollment periods.
Student health plans have long been a source of coverage for college students who do not have other options available. In 2012, the U.S. Department of Health and Human Services redefined student health plans under the Affordable Care Act (ACA), requiring that they be treated like individual health insurance. This means that students buying these plans through their college or university now have the same protections available to them as if they bought a plan in the individual market. It also means that states and the federal government have a new role in oversight of these plans.
The State Network team mourns the recent passing of our dear friend and colleague, Andy Hyman. Andy was the father of the State Network, seeing the value in connecting states with the expertise they need to achieve the vision of coverage that drove him every day.