“After declines in enrollment from 2017 through 2019, preliminary data for January 2022 show that total Medicaid/CHIP enrollment grew to 87.0 million, an increase of 15.7 million from enrollment in February 2020 (22.1%), right before the pandemic and when enrollment began to steadily increase (Figure 1).1 Increases in enrollment may reflect changes in the economy and changes in policy (like recent adoption of the Medicaid expansion in the Affordable Care Act) as well as provisions in the Families First Coronavirus Response Act (FFCRA) that require states to ensure continuous enrollment to current Medicaid enrollees to access a temporary increase in the Medicaid match rates. The continuous enrollment requirement under the FFCRA has halted churning in Medicaid – the temporary loss of coverage in which enrollees disenroll and then re-enroll within a short period of time – in addition to preventing Medicaid coverage loss during the public health emergency. While enrollment has increased for 23 consecutive months, the monthly increases appear to be slowing compared to April through August 2020, when monthly increases were the largest.”
Source: Corallo B, Moreno S. Analysis of recent national trends in Medicaid and CHIP enrollment [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; May 2, 2022. Accessed May 9, 2022.
“Across the four states and four specialties in this study, more than a third of the physicians listed in provider network directories for Medicaid managed care plans treated ten or fewer Medicaid beneficiaries in a year. The share of these low-volume physicians varied little across states, suggesting a widespread mismatch between the physicians listed in provider network directories and those actively seeing Medicaid managed care beneficiaries. Among the set of contracted physicians who saw Medicaid beneficiaries, care was highly concentrated: The top quartile of primary care physicians, cardiologists, and psychiatrists were responsible for 86.2 percent, 69.2 percent, and 86.5 percent of claims, respectively. Taken together, our findings suggest that provider network directories may overstate the availability of physicians in the Medicaid program; many states’ reliance on directories to ensure network adequacy may be insufficient to ensure satisfactory access to physicians who are both valued by Medicaid managed care beneficiaries and willing to treat them.”
Source: Avital B. Ludomirsky, William L. Schpero, Jacob Wallace, Anthony Lollo, Susannah Bernheim, Joseph S. Ross, and Chima D. Ndumele. In Medicaid Managed Care Networks, Care Is Highly Concentrated Among A Small Percentage Of Physicians. Health Affairs 2022 41:5, 760-768.
“An estimated 66 million individuals (20.6% of the U.S. population) received Medicaid or CHIP in 2017, and the programs accounted for $600 billion (18.0% of overall HCE). This spending is about 10 percentage points higher than Medicaid/CHIP’s percentage of total HCE in 1970 (Figure 2). Furthermore, Medicaid spends the highest percentage of expenditures on long-term services and supports, which includes (1) other health, residential, and personal care; (2) nursing care facilities and continuing care retirement communities; and (3) home health care (Figure 1). Long-term services and supports also includes some post-acute care (i.e., skilled care provided over a short term, typically after a hospitalization).”
Source: Congressional Research Service. In Focus: U.S. Health Care Coverage and Spending. Updated March 21, 2019.
“Title XIX of the Social Security Act is a Federal/State entitlement program that pays for medical assistance for certain individuals and families with low incomes and resources. This program, known as Medicaid, became law in 1965 as a cooperative venture jointly funded by the Federal and State governments (including the District of Columbia and the Territories) to assist States in furnishing medical assistance to eligible needy persons. Medicaid is the largest source of funding for medical and health-related services for America’s low-income population.
“Within broad national guidelines established by Federal statutes, regulations, and policies, each State establishes its own eligibility standards; determines the type, amount, duration, and scope of services; sets the rate of payment for services; and administers its own program. Medicaid policies for eligibility, services, and payment are complex and vary considerably, even among States of similar size or geographic proximity. Thus, a person who is eligible for Medicaid in one State may not be eligible in another State, and the services provided by one State may differ considerably in amount, duration, or scope from services provided in a similar or neighboring State. In addition, State legislatures may change Medicaid eligibility, services, and/or reimbursement at any time.
“Title XXI of the Social Security Act, the Children’s Health Insurance Program (CHIP, known from its inception until March 2009 as the State Children’s Health Insurance Program or SCHIP), is a program initiated by the Balanced Budget Act of 1997 (BBA; Public Law 105-33). The BBA provided $40 billion in Federal funding through fiscal year (FY) 2007 to be used to provide health care coverage for low-income children—generally those in families with income below 200 percent of the Federal poverty level (FPL)—who do not qualify for Medicaid and would otherwise be uninsured. CHIP funding was extended through FY 2027 by subsequent legislation, including the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA; Public Law 111-3); the Patient Protection and Affordable Care Act (Public Law 111-148) as amended by the Health Care and Education Reconciliation Act of 2010 (Public Law 111-152)—collectively referred to as the Affordable Care Act; the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA; Public Law 114-10); the Federal Register Printing Savings Act of 2017 (Public Law 115-120); and the Bipartisan Budget Act of 2018 (Public Law 115-123). Under CHIP, States may elect to provide coverage to qualifying children by expanding their Medicaid programs or through a State program separate from Medicaid. A number of States have also been granted waivers to cover parents of children enrolled in CHIP.”
Source: Brief Summaries of Medicare & Medicaid, Title XVIII and Title XIX of The Social Security Act as of October 15, 2018. Prepared by Barbara S. Klees, Eric T. Eckstein II, and Catherine A. Curtis, Office of the Actuary Centers for Medicare & Medicaid Services, Department of Health and Human Services, December 2018.
Fact Items Related To Medicaid
- Medicaid Overview“Medicaid is a joint federal-state program that finances the delivery of primary and acute medical services, as well as long-term services and supports (LTSS), to a diverse low-income population, including children, pregnant women, adults, individuals with disabilities, and people aged 65 and older. “State participation in Medicaid is voluntary, although all states, the District of Columbia, ...
- Medicaid Enrollment“The ACA Medicaid expansion has significantly increased Medicaid enrollment and federal Medicaid expenditures. In FY2017, an estimated 12 million individuals were newly eligible for Medicaid through the ACA Medicaid expansion (i.e., expansion adults), and total Medicaid expenditures for the expansion adults were an estimated $71 billion. Enrollment for the expansion adults is projected to be ...
- Financial Eligibility for Medicaid“Medicaid is also a means-tested program that is limited to those with financial need. However, the criteria used to determine financial eligibility—income and sometimes resource (i.e., asset) tests—vary by eligibility group. “For most eligibility groups the criteria used to determine eligibility are based on modified adjusted gross income (MAGI) income counting rules. There is no resource ...
- Categorical Eligibility for Medicaid“Medicaid categorical eligibility criteria are the characteristics that define the population qualifying for Medicaid coverage under a particular eligibility pathway; in other words, the nonfinancial requirements that an individual must meet to be considered eligible under an eligibility group. Medicaid covers several broad coverage groups, including children, pregnant women, adults, individuals with disabilities, and individuals ...
- Medicaid Expenditures“The cost of Medicaid, like most health expenditures, historically increased at a rate significantly faster than the overall rate of U.S. economic growth, as measured by gross domestic product. In the past, much of Medicaid’s expenditure growth has been due to federal or state expansions of Medicaid eligibility criteria, such as the ACA Medicaid expansion. “Medicaid ...
- Medicaid Financing“The federal government and the states jointly finance Medicaid.47 The federal government reimburses states for a portion (i.e., the federal share) of each state’s Medicaid program costs. Because federal Medicaid funding is an open-ended entitlement to states, there is no upper limit or cap on the amount of federal Medicaid funds a state may receive. ...
- State Share of Medicaid Financing“The federal government provides broad guidelines to states regarding allowable funding sources for the state share (also referred to as the nonfederal share) of Medicaid expenditures. However, to a large extent, states are free to determine how to fund their share of Medicaid expenditures. As a result, there is significant variation from state to state ...
- Federal Share of Medicaid Financing“The federal government’s share of most Medicaid expenditures is established by the federal medical assistance percentage (FMAP) rate, which generally is determined annually and varies by state according to each state’s per capita income relative to the U.S. per capita income.49 The formula provides higher FMAP rates, or federal reimbursement rates, to states with lower ...
- Medicaid Expansion Under the ACA“Since January 1, 2014, states have had the option to extend Medicaid coverage to most non-elderly, nonpregnant adults with income up to 133% of FPL. Twenty-four states and the District of Columbia implemented the ACA Medicaid expansion at that time. Since then, the following seven states have implemented the expansion: Michigan (April 1, 2014), New ...
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Page last updated May 9, 2022 by Doug McVay, Editor.