A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Medicaid and CHIP

NBER study discusses positive impact of including dental benefits in Medicaid

Posted on April 22, 2014

A new study released by the National Bureau of Economic Research (NBER) indicates that including adult dental benefits in Medicaid plans can have a multitude of positive results. The study, How Do Providers Respond to Public Health Insurance Expansions? Evidence from Adult Medicaid Dental Benefits, found that covering dental benefits resulted in more dentists participating in Medicaid without decreasing the number of privately insured patients these dentists see. Additionally, the study reported that dentists participating in Medicaid were able to make greater use of dental hygienists while only mildly increasing patient wait times.

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Update: State Medicaid, Marketplace and Navigator Law Status

Posted on April 11, 2014

Click here to see an updated version of our HealthReformGPS map that provides a comprehensive depiction of each state’s status on Medicaid expansion, Marketplace operations, and Navigator laws. Note that partnership marketplaces are considered federally-facilitated marketplaces for the purposes of this map.

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CMS releases BHP final rule

Posted on March 7, 2014

The Centers for Medicare and Medicaid Services (CMS) released a final rule and payment notice for the Basic Health Program (BHP). Under the Affordable Care Act (ACA), many individuals will have an income too high to qualify for Medicaid, yet subsidies may not make their health insurance affordable. BHP, a program aiming to reduce churning between Medicaid and private coverage, helps to ensure continuity of care for individuals with fluctuating incomes. The rule allows for states to receive funding for BHP beginning in 2015.

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CMS issues DSH allotments

Posted on February 27, 2014

The Centers for Medicare and Medicaid Services (CMS) issued the funding allocation for disproportionate share hospitals (DSH) for FY 2014. DSH payments are typically provided to hospitals that treat a disproportionate number of uninsured or under-insured patients. The Affordable Care Act (ACA) originally called for a cut in DSH payments, as more Americans would presumably be insured under Medicaid. The Supreme Court ruling that made Medicaid expansion optional, however, ultimately coerced CMS to delay DSH cuts for two years.

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GAO report finds states spend one-third of Medicaid dollars on few beneficiaries

Posted on February 20, 2014

The Government Accountability Office (GAO) released a new report citing how Medicaid spends a third of their funds on a small sect of high-expenditure Medicaid beneficiaries. The report, Medicaid: Demographics and Service Usage of Certain High-Expenditure Beneficiaries, found that states spent 31.6% of all Medicaid expenditures on 4.3% of the Medicaid population. Furthermore, the report stated that certain characteristics, such as residing in a long-term care facility, contributed to individuals being deemed high-expenditure Medicare beneficiaries.

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CMS documents describe presumptive eligibility

Posted on January 28, 2014

The Centers for Medicare and Medicaid Services (CMS) issued a bulletin and question-and-answer explaining hospital presumptive eligibility. The documents are intended to aid hospitals in determining individual eligibility for Medicaid, or presumptive eligibility, under the Affordable Care Act (ACA). The documents provide relevant information on eligible populations, entities that can make coverage determinations, qualification standards, and federal matching assistance that may be relevant for hospitals that may treat patients without insurance. All states are expected to include an amendment to their Medicaid State Plans implementing the new presumptive eligibility standards.

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CMS finds 6.3 million eligible for Medicaid or CHIP

Posted on January 24, 2014

The Centers for Medicare and Medicaid Services (CMS) issued a new report chronicling the numbed of individuals deemed eligible for Medicaid or the Children’s Health Insurance Program (CHIP) during the first three months of open enrollment. The report stated that 6.3 million Americans enrolled in Medicaid or CHIP in state-based Marketplaces or in-person at state Medicaid offices. The report does not, however, provide numbers for Medicaid enrollment in federally-facilitated Marketplaces, nor does it differentiate between individuals that are newly eligible for Medicaid as a result of expansion and those that were previously eligible under the original Medicaid criteria.

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Update: Medicaid Expansion Map

Posted on January 13, 2014

This updated map reflects the recent acceptance of Wisconsin’s 1115 demonstration waiver to permit childless adults earning up to 100% of the federal poverty level (FPL) to receive health coverage from Wisconsin’s Medicaid program, BadgerCare.

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CMS approves WI Medicaid waiver

Posted on January 13, 2014

Last week. the Centers for Medicare and Medicaid Services (CMS) approved a 1115 demonstration waiver for Wisconsin to expand the state’s Medicaid program, BadgerCare.  The waiver expands Medicaid to childless adults earning up to 100% of the federal poverty level (FPL).  Individuals previously enrolled in Wisconsin’s BadgerCare Plus program and those deemed newly eligible for Medicaid under the Affordable Care Act’s (ACA) criteria will be placed on the federal health insurance Marketplace operating in Wisconsin.  The waiver went into effect on January 1st, 2014.

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New GAO report finds similarities among state CHIP plans

Posted on January 2, 2014

A new report from the Government Accountability Office (GAO) examined Children’s Health Insurance Program (CHIP) plans from five states and compared these plans to each state’s respective benchmark Qualified Health Plan (QHP) offered through the Affordable Care Act (ACA). Overall, GAO found the CHIP plans were comparable to the benchmark plans in terms of the services covered and the limitations placed upon those services. The cost of these services to the consumers, however, was generally less for the CHIP plans than for the benchmark plans. Plan usage for certain services was one difference detected between the two plans. For instance, CHIP beneficiaries reported more usage of emergency room services compared to individuals with private insurance.

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