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Restructuring Medicaid: Key Elements and Issues in Section 1115 Demonstration Waivers

This policy brief provides background on Section 1115 Medicaid waiver activity, discusses the common provisions of the approved and proposed Section 1115 waivers since 1993, and briefly summarizes the current application of Section 1115 AFDC waivers. It also examines implications of the Section 1115 waivers on the Medicaid program and…

Massachusetts Health Care Reform: Six Years Later

In 2006, then-Gov. Mitt Romney signed Massachusetts’ comprehensive health reform designed to provide near-universal health insurance coverage for state residents. Building on a long history of health reform efforts, the state embarked on an ambitious plan to promote shared individual, employer, and government responsibility. This brief examines Massachusetts’ experience with…

Recent Growth in Medicaid Home and Community-Based Service Waivers

Medicaid spending on home and community-based service (HCBS) waivers dominates spending on community-based long-term care services offered through the Medicaid program. This paper examines trends in HCBS waiver enrollment and spending in recent years. Report (.pdf)

The Impact of Medicaid Reductions in Oregon:  Focus Group Insights

The Impact of Medicaid Reductions in Oregon: Focus Group InsightsOregon is one state that has significantly restructured its Medicaid program, known as the Oregon Health Plan (OHP), in response to budget pressures. As part of these changes, it has implemented significant benefit reductions and increased premiums and cost sharing in…

Increasing Premiums and Cost Sharing in Medicaid and SCHIP: Recent State Experiences

Over the past few years, a number of states have implemented new or increased existing out-of-pocket costs for beneficiaries in their Medicaid, SCHIP, or other public coverage programs. This brief reviews the key findings from this recent activity, including the impact on enrollment in public coverage programs, access to care,…

Choosing Premium Assistance: What Does State Experience Tell Us?

Premium assistance programs use federal and state Medicaid and State Children’s Health Insurance Program (SCHIP) funds to purchase private coverage. Overall, few states have premium assistance programs, but interest in premium assistance remains high. This brief examines six state premium assistance programs (in Florida, Idaho, Illinois, Oregon, Utah, and Virginia)…

Coverage Gains Under Recent Section 1115 Waivers: A Data Update

This brief assesses the extent to which recent Section 1115 waivers have helped reduce the number of uninsured people and finds that there has been a net gain in coverage of 426,329 people under recent waivers.Issue Paper (.pdf)