2015 State Medicaid Report
HIDA’s annual State Medicaid Report outlines key policies impacting the post-acute care market including the expansion of home and communitybased services and the increase of Medicaid managed long-term care services and supports programs. The report also highlights reimbursement and budget allocations, where available, for each state’s Medicaid program for FY 2015.
Medicaid is the largest payer of long-term services and supports (LTSS), which include non-institutional services such as personal care, Section 1915(c) waiver services, and rehabilitative services, and institutional services such as nursing homes, intermediate care facilities for individuals with intellectual disabilities (ICF/IID) and mental health facilities. The report captures the most recent comprehensive state-by-state Medicaid expenditure data for LTSS as released by the Centers for Medicare & Medicaid Services (CMS) in October 2014. The data includes funding allocated via the Money Follows the Person (MFP) rebalancing demonstration, which provides participating states with an increase in federal matching for up to one year for each eligible Medicaid beneficiary transitioned out of an institution into a community-based setting. The data also captures funding allocated to the Program for All-Inclusive Care for the Elderly (PACE), which provides comprehensive and coordinated long-term services and supports to Medicaid and Medicare enrollees at home rather than in a nursing home.
The report also captures whether state decisions have been made on two key healthcare reform provisions:
1. Medicaid expansion
2. Type of health insurance exchange
The report was updated December 2014 to reflect the most recent status of the Medicaid expansion and the type of health insurance exchange to be administered in each state. Every effort has been made to capture current information for each state. However, there are some inconsistencies where the aforementioned information was unclear, not easily accessible, or unavailable at the time of publication due to various state budgetary practices. If you have any questions regarding Medicaid and its impact on the healthcare continuum, please contact Erik Rison at 703-838-6133 or firstname.lastname@example.org, or Amy Kohl at 703-838-6121 or email@example.com.
Below are highlights of the Medicaid trends tracked in the report.
HOME AND COMMUNITY-BASED SERVICES EXPANSION
State Medicaid budgetary spending on LTSS continues to grow, and as a result, state and federal efforts are underway to expand the use of non-institutional LTSS care options to help curb spending.
Forty-seven states, 5 from FY 2014 to FY 2015, have decided to expand home and community-based services (HCBS) programs to enable people with disabilities to receive healthcare services in their homes and community rather than be institutionalized, which is a more costly model of care.
Much of the expansion activity is a result of provisions included in healthcare reform that incentivize states, through enhanced federal Medicaid matching rates, to expand the use of non-institutional options.
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MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS
Increasing numbers of states are transitioning their Medicaid LTSS systems from fee-for-service models to managed care models.
The number of states with MLTSS programs increases every year and now totals 28. The total number of persons receiving LTSS through managed care programs is 389,000.
Eighteen states currently offer MLTSS programs in some areas, while 28 states are operating MLTSS programs statewide. This number is expected to increase in 2015, based on the states that have completed planning documents and submitted formal proposals or waiver applications to CMS.
OVERALL FY 2015 MEDICAID FUNDING
State Medicaid budgets are expected to grow as some states expand their Medicaid rolls under the Affordable Care Act’s (ACA) 2014 expansion provision. In 2017, states that have expanded their Medicaid programs under the ACA will have to begin paying for a larger portion of their Medicaid budget as federal funding decreases.
According to the Congressional Budget Office (CBO), federal spending for Medicaid in FY 2014 was $299 billion. Over the next decade, federal Medicaid expenditures are expected to grow by an average annual rate of about 7%.
Over the next decade CBO expects federal spending to grow to $576 billion by 2024.
As of January 2015, 28 states and the District of Columbia have indicated they would expand Medicaid eligibility in line with the ACA. Of the remaining 22 states, a handful (Alaska, Indiana, Montana, Tennessee, Utah, Virginia, and Wyoming) have submitted proposals to the U.S. Department of Health and Human Services that would allow them to use federal Medicaid dollars on alternate plans to cover more low-income residents. The remaining states are opting out.
The Congressional Budget Office estimates that the Medicaid expansion is projected to provide health coverage to 93 million by 2024 (as of 2013, Medicaid covers 73 million people).
STATE HEALTH INSURANCE EXCHANGE
States have the option of operating their own exchange or partnering with the federal government to run an exchange. States choosing neither option will default to a federally facilitated exchange.
As of December 2014, 14 states will operate state-based exchanges; 27 states will operate federally facilitated marketplaces, 7 states will operate partnership exchanges, 3 states will operate state-based Small Business Health Options Programs (SHOP) with federally facilitated individual marketplaces.
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