This brief reviews the role of Medicaid in financing and enabling access to family planning services for low-income women; discusses how states have expanded access to these services with Medicaid; and highlights future programmatic challenges in the context of the health care delivery and coverage reforms resulting from the Affordable Care Act (ACA).
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Demonstrations to Improve the Coordination of Medicare and Medicaid for Dually Eligible Beneficiaries: What Prior Experience Did Health Plans and States Have with Capitated Arrangements?
This report examines the Center for Medicare and Medicaid Services (CMS) financial alignment demonstration for beneficiaries dually eligible for Medicare and Medicaid, with a focus on the extent to which participating states and health plans have prior experience with capitated managed care arrangements under Medicare or Medicaid, and specifically for this population. Under these capitated financial alignment demonstrations, health plans contract with the state and CMS (a three-way contract) to provide both Medicare and Medicaid benefits to dually eligible beneficiaries. These demonstrations aim to improve the quality of care and the coordination of benefits for people dually eligible for Medicare and Medicaid. The report finds considerable variation in the experience of states and health plans participating in these demonstrations, and discusses the potential implications for beneficiaries and plan oversight.
In states that do not implement the Medicaid expansion under the Affordable Care Act (ACA), many adults will fall into a “coverage gap” of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits. Nationwide, nearly four million poor uninsured adults are in this situation.This brief describes the population in the coverage gap and discusses the implications of them being left out of ACA coverage expansions.
In his latest column for The Wall Street Journal’s Think Tank, Drew Altman analyzes whether public or private health insurance does a better job of controlling costs. All previous columns by Drew Altman are available online.
In this column for The Wall Street Journal’s Think Tank, Drew Altman analyzes whether public or private health insurance does a better job of controlling costs.
Building on an earlier brief that provided an overview of the components of DSRIP waivers, this analysis relied upon interviews with stakeholders to identify emerging trends and themes from DSRIP waivers in four states – California, Massachusetts, New York and Texas. It highlights that DSRIP waivers are spurring major change in relationships among providers; allowing providers to launch new initiatives aimed at improving care and reducing costs; and fostering a stronger focus on the social service needs of Medicaid beneficiaries. At the same time, the rapid pace of implementation is straining the ability of stakeholders to keep pace, including consumer advocates who are hard-pressed to track and respond to the DSRIP-driven changes that are fundamentally re-shaping the way that care is delivered to Medicaid beneficiaries.
With Medicare and Medicaid turning 50 this year, this updated video provides a brief history of both programs, including: an examination of the health care, social and political landscape that gave rise to them, the significant ways each program has evolved over five decades, and the important roles they play in the U.S. health care system. The video includes archival footage, as well as commentary and perspective from policymakers, government officials and experts.
Where Are States Today? Medicaid and CHIP Eligibility Levels for Adults, Children, and Pregnant Women
This fact sheet provides an overview of eligibility levels for parents, other non-disabled adults, children, and pregnant women in Medicaid and CHIP. The data are based on eligibility levels reported by states as of January 2015, updated to reflect state Medicaid expansion decisions as of April 2015. The findings highlight Medicaid’s expanded role for low-income adults under the Affordable Care Act (ACA) and its continued role as a primary source of coverage for children and pregnant women.
The Affordable Care Act (ACA) went into full effect on January 1, 2014, ushering in health insurance reforms and new health coverage options in Pennsylvania and elsewhere across the country. Pennsylvania is experiencing changes to its health care delivery system as the state expands Medicaid, provides new coverage options through the federal health insurance marketplace, streamlines application and enrollment processes for coverage programs, and implements new health care delivery system and payment reforms. This fact sheet provides an overview of population health, health coverage, and the health care delivery system in Pennsylvania in the era of health reform.
The Affordable Care Act (ACA) expansion of Medicaid to adults with incomes at or below 138% of the federal poverty level (FPL) effectively became a state option following the Supreme Court decision, creating a “coverage gap” for many poor uninsured adults in states that do not expand Medicaid. This brief examines the coverage gap by race and ethnicity.