California

Medicaid Enrollees Are Largest Share of Newly Insured

A new survey from the Kaiser Family Foundation found that 33% of Californians uninsured in 2013 are now enrolled in Medi-Cal, the State’s Medicaid program. That percentage accounts for the largest share of Californians that have gained health insurance since 2013, when Governor Jerry Brown (D) signed legislation expanding Medicaid. The survey also found that 27% of those who remain uninsured have incomes that would likely make them eligible for Medi-Cal under expansion. In total, 72% of Californians uninsured in 2013 now have health coverage. Of the remaining uninsured nearly half cite cost as their main barrier to coverage. Compared to a 2013 baseline survey, Californians with health insurance today are more likely to report that their healthcare needs are being met and that they are less concerned with healthcare costs.

Indiana

State Requests Continuation of Non-Emergency Transportation Waiver for Most Medicaid Expansion Enrollees

Indiana has submitted a request to extend the temporary waiver of non-emergency medical transportation (NEMT) in its Medicaid expansion program—“Healthy Indiana Plan (HIP) 2.0”—until the end of the demonstration period on January 31, 2018. The current NEMT waiver was granted with the requirement that the State study and report the waiver’s impact on member access to care prior to requesting an extension. The State’s request cites findings from its 2015 and 2016 evaluations, which indicate that a relatively small number of HIP 2.0 enrollees missed appointments due to transportation issues and that those without NEMT coverage did not experience more transportation issues. The waiver would continue to exclude certain populations, such as pregnant women and the medically frail.

Indiana

CMS Denies Requested Amendments to Medicaid Expansion, Including New Lockout Period

CMS denied the State's request to add a six-month lockout period for all Medicaid expansion enrollees who do not complete the annual renewal process, which would have barred nearly 19,000 people from coverage each year. In a letter to Governor Mike Pence (R), CMS noted that it has not approved a lockout period for enrollees below 100% of FPL in any state waiver. CMS also rejected the State's request to discontinue a “prior claims payment program,” which provides retroactive coverage of medical costs incurred by a parent in the year before their enrollment in Healthy Indiana Plan (HIP) 2.0 (the State’s Medicaid expansion program). Prior to receiving Indiana’s request, CMS had established that this program could only be discontinued if data indicated it was needed by 5% or less of parents enrolled in HIP 2.0 for three consecutive months. Nearly 14% of eligible individuals are incurring costs that would have been reimbursed in the absence of the demonstration, according to the State’s latest data.

Oregon

Study Finds Correlation Between ACA and Improved Financial Health of Hospitals

An Oregon Health Authority (OHA) study found a 38% increase in operating margins and a 40% decrease in uncompensated care across Oregon's 60 acute care hospitals between 2014 and 2015. The study, which also found a 38% reduction in bad debt, attributes this improved financial performance to a 9% drop in the uninsurance rate, spurred by the State's adoption of Medicaid expansion and its establishment of a State-based Marketplace. The study's authors analyzed annual financial reports that acute care hospitals are mandated to submit to OHA.

National News

Brief Explores Medicaid Funding Options for Social Service Interventions

A new brief prepared by Manatt Health for the Milbank Memorial Fund and the New York State Health Foundation reviews how states can use Medicaid to facilitate access to social services including housing services, employment and job stability programs, and peer and community supports. The brief, which is based on regulatory review and interviews with state and federal experts, notes that Medicaid expansion is one of several factors driving states’ interest in connecting Medicaid enrollees with social support services, due to the increased number of adults with health conditions linked to social and economic challenges in expansion states. The authors describe 1115 Medicaid waivers as “by far the most flexible vehicle” that states have to integrate social services into their Medicaid programs, though the authors caveat that securing an 1115 waiver can be a lengthy process. The brief also finds that states can include case management, preventive and rehabilitative services, habilitation services, and Health Home services in their benefit packages through State Plan Amendments, noting that expansion states receive an enhanced federal match for Health Home services delivered to newly eligible adults in perpetuity (non-expansion states receive the enhanced match for eight quarters).

Non-Expansion States Would Net Up to $8 for Each State Dollar Spent on Expansion

If the 19 states that have not yet expanded Medicaid opted to do so, they would draw down between $7 and $8 in net federal funding for each state dollar spent over the next 10 years, according to an Urban Institute report. The additional enrollment would raise state spending between $75.9 billion and $83.5 billion while federal spending would increase between $568.5 billion and $634.5 billion, assuming an enrollment rate between 70% (a “moderate” rate) and 88% (a “high” rate). Federal spending on Marketplace subsidies would decrease by $129.1 billion and on uncompensated care by between $34.9 billion and $43.3 billion. State spending on uncompensated care would decrease between $21.8 billion and $27.1 billion. Over the ten-year projection period, Mississippi would see the greatest gain in federal net dollars, followed by Tennessee and Alabama. The study does not incorporate state revenue gains or cost savings from expansion that have been found to exceed expansion costs in “every broad fiscal review” done in expansion states thus far.

Prescription Drug Use Up and Out-of-Pocket Spending Down for Newly Insured

A new study published in Health Affairs found a “dramatic increase” in prescription drug use among uninsured individuals who gained either private coverage or Medicaid between 2013 and 2014. The study reviewed prescription transaction data for 6.7 million individuals and found that individuals who gained Medicaid filled 79% more prescriptions on average and had 58% less out-of-pocket spending per prescription than they did in 2013. Those who gained private coverage filled 28% more prescriptions and had 29% lower out-of-pocket spending per prescription than they did in 2013.

Medicaid Expansion Enrollees Report Increased Access and Reduced Costs, Study Finds

Medicaid expansion is associated with significant increases in outpatient and primary care utilization, improved self-reported health, and reduced emergency department use, according to a new study published by JAMA Internal Medicine. The study evaluated expansion’s impact on low-income adults in Kentucky and Arkansas compared to their counterparts in Texas, a non-expansion state. While Kentucky enrolled the expansion population in managed care plans and Arkansas used private Marketplace plans (the “private option”), both states experienced comparable healthcare improvements, though Kentucky had higher diabetic glucose testing rates. Both states’ expansions were associated with a nearly 30% reduction in out-of-pocket spending, a significant increase in screenings and treatments for chronic diseases, and significant improvements in quality of care ratings. The authors, who based their findings on statistical analysis of survey results from nearly 9,000 respondents, note that Kentucky’s and Arkansas’s coverage expansions took more than one year to mature, suggesting that early evaluations of expansion likely underestimate its long-term impacts.

Medicaid Expansion Improves Care Continuum for Justice-Involved Populations

Medicaid expansion is the first “widespread opportunity” states have to connect justice-involved adults with the physical and behavioral health services they need, according to a Center for Health Care Strategies paper commissioned by Milbank Memorial Fund’s Reforming States Group. In addition to increasing access to healthcare services, enrolling eligible justice-involved individuals in Medicaid reduces the cost to states—and to counties—of providing those services. For citizens and documented immigrants in jail or prison with little to no income, Medicaid eligibility is “nearly a sure bet” in expansion states. The paper details states’ options for providing Medicaid services to justice-involved individuals using 1115 waivers, health homes, and home- and community-based waivers. It also reviews enrollment strategies and Medicaid services currently being accessed by some justice-involved individuals transitioning back to their communities, such as case management and integrated mental health services.

Expansion Did Not Impact Employment Rates Among the Newly-Eligible, Study Finds

A new study published by the National Bureau of Economic Research (NBER) found that Medicaid expansion has not significantly impacted employment among childless adults newly eligible for health coverage under Medicaid expansion, despite previous findings and predictions that expansion might hasten exits from the workforce by those who remained employed to maintain access to affordable health insurance. NBER researchers did not find evidence of lower employment in expansion states compared to non-expansion states, or reduced work hours for expansion enrollees.