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  • “Partial Medicaid Expansion” with ACA Enhanced Matching Funds: Implications for Financing and Coverage

    Issue Brief

    The Affordable Care Act (ACA) provides enhanced federal matching funds to states that expand Medicaid to nonelderly adults up to 138% of the federal poverty level (FPL, $17,236/year for an individual in 2019). The ACA enhanced match (93% in 2019, and 90% in 2020 and thereafter) is substantially higher than states’ traditional Medicaid matching rate. A few states have sought Section 1115 demonstration waiver authority from the Centers for Medicare and Medicaid Services (CMS) to receive the substantially higher ACA enhanced match while limiting coverage to individuals at 100% FPL, instead of covering the full 138% FPL ACA group. To date, CMS has allowed states to receive the ACA enhanced Medicaid matching funds only if the entire expansion group is covered. CMS has not approved waiver requests seeking enhanced ACA matching funds for a partial coverage expansion in Arkansas or Massachusetts, while a request is pending in Utah. This brief explores the current rules for partial expansion and explains some of the potential implications for financing and coverage if CMS approves waivers to allow for partial expansion with enhanced matching funds.

  • The U.S. Government and Multilateral Global Health Engagement: 5 Key Facts

    Issue Brief

    With ongoing questions about future U.S. support for multilateral health efforts as well as important markers on the near horizon, including donor replenishment conferences for both the Global Fund and Gavi within the next two years, this brief highlights five key facts about U.S. engagement with multilateral global health organizations.

  • The U.S. Government Engagement in Global Health: A Primer

    Report

    This primer provides basic information about global health and U.S. government programs that address global health. The first several sections provide an overview of the field of global health and describe current global health issues. The subsequent sections describe U.S. government support for global health, from the programs the government supports, to the organization of the U.S. response, the budgets and financing of U.S. global health programs, and the U.S. government’s relationship with multilateral institutions and international partners.

  • Medicaid in the Territories: Program Features, Challenges, and Changes

    Issue Brief

    This brief draws on a survey of and interviews with Medicaid officials in U.S. Territories, as well as other research, to examine key issues and trends in their Medicaid programs. Territories differ from the states on key demographic, economic, and health status indicators. Unlike in the states, where federal Medicaid funding is not capped, and the federal share varies based on states’ per capita income, Medicaid in the territories is subject to a statutory cap and a fixed federal matching rate.

  • As People Lose Jobs Due to the Coronavirus Crisis and Enroll in Medicaid, Survey Finds States Anticipate Medicaid Budget Shortfalls

    News Release

    Many states that shared budget projections in response to a new KFF survey of state Medicaid officials report that they expect to see Medicaid budget shortfalls due to rising Medicaid spending and enrollment as people lose jobs amid the coronavirus pandemic and more people enroll in the government health insurance program for low-income people.

  • Early Look at Medicaid Spending and Enrollment Trends Amid COVID-19

    Issue Brief

    The coronavirus pandemic has generated both a public health crisis and an economic crisis, with major implications for Medicaid, a countercyclical program. During economic downturns, more people enroll in Medicaid, increasing program spending at the same time state tax revenues may be falling. To help support states as enrollment in Medicaid grows and ensure existing enrollees maintain continuous coverage, the Families First Coronavirus Response Act (FFCRA) authorized a 6.2 percentage point increase in the federal match rate (“FMAP”) (retroactive to January 1, 2020) available if states meet certain “maintenance of eligibility” (MOE) requirements. This brief provides some early insights into the current picture of Medicaid spending and enrollment, as Congress considers providing additional fiscal relief through the federal Medicaid match rate.

  • Distribution of CARES Act Funding Among Hospitals

    Issue Brief

    This brief analyzes the distribution of $50 billion in CARES Act funding for providers and shows that the distribution formula selected by the Department of Health and Human Services favored hospitals with a relatively high share of revenue from private insurance. Hospitals that see a smaller share of patients with private insurance and instead see more patients with Medicare or Medicaid received less funding per hospital bed.