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The ACA and Medicaid Expansion Waivers

This brief focuses on Section 1115 Medicaid demonstration waivers related to implementation of the ACA Medicaid expansion (eligible for ACA enhanced matching funds) or other coverage (not eligible for ACA enhanced matching funds). To date, the Centers for Medicare and Medicaid Services (CMS) has approved waivers to implement the Medicaid expansion in five states: Arkansas, Iowa, Michigan, Pennsylvania and most recently Indiana. In addition, Pennsylvania has a waiver proposal. In addition, New Hampshire has a proposal pending with CMS, and Governors in both Tennessee and Utah have been negotiating plans with CMS, but these plans also need to be approved by the state legislature.

Are Uninsured Adults Who Could Gain Medicaid Coverage Working?

As additional states consider whether to implement the ACA Medicaid expansion, some have raised pursuing waiver authority to tie Medicaid eligibility for adults under the expansion to work requirements. This fact sheet profiles uninsured adults who could gain Medicaid coverage under the ACA by their relationship to the workforce and job-based coverage.

An Overview of Actions Taken by State Lawmakers Regarding the Medicaid Expansion

The ACA Medicaid expansion has garnered different responses from statelawmakers – Democratics and Republicans as well as governors and legislatures. While it does not cover how every state has enacted the ACA Medicaid expansion, this fact sheet highlights some of the different actions state lawmakers have taken in response to the ACA Medicaid expansion.

Trends in Medicaid Spending Leading up to ACA Implementation

This paper presents data on Medicaid spending during the years leading up to the implementation of the Affordable Care Act (ACA). It uses administrative data to first examine overall spending trends and trends by service type. We then draw on additional data to analyze per enrollee spending growth during this period, both by service type and by eligibility group, to understand what drove Medicaid spending.

Medicaid Expansion in Iowa

This fact sheet summarizes key features of IA’s Medicaid expansion waivers.

Safety-Net Emergency Departments: A Look at Current Experiences and Challenges

Safety-net hospital emergency departments (EDs) are an important part of our health care system, especially, but not only, for the uninsured and others with low income. With multiple major changes unfolding in our system today, including the development of new models of health care delivery, payment reforms, expanded insurance coverage, and increasing demand for primary care access, safety-net EDs are a sort of crucible in which these shifts and transitions can be seen playing out. To understand more about their current experiences and challenges as the Affordable Care Act (ACA) begins to takes hold, we conducted interviews with ED directors in a convenience sample of 15 safety-net hospitals around the country in June and July 2014.

Medicare Spending Peaks at Age 96  

In his latest column for The Wall Street Journal’s Think Tank, Drew Altman discusses the implications of a Kaiser finding: per capita Medicare spending peaks at age 96, and the main reason is not end-of-life care. All previous columns by Drew Altman are available online.

State Demonstration Proposals to Integrate Care and Align Financing and/or Administration for Dual Eligible Beneficiaries

This map shows the current status of the state demonstration proposals to integrate care and align financing for beneficiaries eligible for both Medicare and Medicaid. Over 9.6 million seniors and younger people with significant disabilities are dually eligible for both programs, and as many as 2 million of them may be included in the demonstrations.