How states are getting ready for ACA Medicaid changes today

The Kaiser Family Foundation has a great report out on how changes to Medicaid in the ACA are already happening today. Here are the take home points:

1. Getting an early start on the Medicaid expansion. Starting April 2010 the ACA provided states a new state plan option to cover adults with incomes up to 133% FPL to get an early start on the 2014 Medicaid expansion. Since April 2010, eight states (CA, CT, CO, DC, MN, MO, NJ, WA) have received approval to expand Medicaid to adults early through the new option and/or a Section 1115 waiver.

2. Increased federal funding to upgrade Medicaid eligibility systems. In April 2011, the federal government approved a temporary funding opportunity, under which states can receive a 90% federal funding match for the design, development, and implementation of major upgrades or new Medicaid eligibility systems, up from the regular 50% administrative matching rate. As of January 1, 2012, 29 states had approved or submitted plans to overhaul or build new systems, and most of the remaining states indicated interest in pursuing an upgrade during 2012.

3. New federal Medicaid funding for disease prevention. Medicaid Incentives for Prevention of Chronic Disease (MIPCD), established by the ACA and administered by CMS, provides a total of $85million over five years (January 1, 2011-December 31, 2015) to test the effectiveness of providing financial and non-financial incentives to Medicaid beneficiaries who participate in prevention programs and demonstrate changes in health risk and outcomes. As of January 1, 2012, ten states (CA, CT, HI, MN, MT, NH, NV, NY, TX, WI) received the first round of MIPCD grant awards.

4. Health homes for individuals with chronic conditions. The ACA provides states with a new option to reform the delivery system for beneficiaries with chronic conditions by providing “health home” services and authorizes a temporary 90% federal match rate for these services. As of April 2012, CMS has approved six state plan amendments (SPA) in four states to provide health home services: two in MO; two in RI, one in NY, and one in OR. There are two additional health home SPAs under review in NC and WA, and CMS is reviewing draft proposals in five states (AL, IA, IL, OH, OK). In addition, CMS has approved funding requests from 15 states for planning activities to develop a health home SPA.

5. Integrating financing and care for dual eligible beneficiaries. As provided by the ACA, in April 2011, the Center for Medicare and Medicaid Innovation, working with the CMS Medicare-Medicaid Coordination Office, awarded design contracts of up to $1 million each to 15 states to develop service delivery and payment models integrating care for beneficiaries dually eligible for Medicare and Medicaid. In addition, as of April 2012, 26 states including the 15 with design contracts) have submitted proposals to test models of integrated care and financing for dual eligible beneficiaries.

I’ve been beating the drum on the importance of, and the magnitude of, Medicaid reforms in the ACA. Although the expansion set to occur in 2014 is what everyone focuses on most, the changes that have occurred already are quite substantial. Should the Supreme Court strike down the entire law next month, rolling back these changes will be incredibly disruptive. The same will be true should the law be repealed next year. As time goes on, “repealing” may be just as politically difficult as “replacing”.


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