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Adam Swanson

Senior Policy Associate, National Council for Behavioral Health

New Report Details Increases in Medicaid Enrollment and Eligibility

October 23, 2013 | Medicaid | Comments
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Enrollment and eligibility in Medicaid will increase for most states in 2014, including the 25 states that have not elected to expand their programs, according to a new report from the Kaiser Commission on Medicaid and the Uninsured. The report details the impending growth of all state Medicaid programs, as well as new care coordination initiatives and provider payment reform. Program changes in 2013 and those anticipated for 2014 directly impact behavioral health providers — Medicaid is the single largest source of financing for mental health and addictions services in the country. The report is based on survey of Medicaid officials in all 50 states and the District of Columbia and includes detailed appendices with state-by-state information.

Some key highlights in the report, Medicaid in a Historic Time of Transformation: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2013 and 2014, include:

  • Growth of Medicaid: Early evidence from states that adopted their own exchanges suggested that enrollment in Medicaid would rise as individuals who applied for exchange coverage were found eligible for Medicaid instead. The report bears out this experience, finding that regardless of a state’s decision to accept the federal Medicaid expansion, enrollment and eligibility in Medicaid will increase for nearly every state in 2014. The influx of new Medicaid beneficiaries will be largely due to the ACA’s requirement for states to coordinated enrollment between Medicaid and the new health insurance Marketplace. Among the 26 states accepting federal expansion funds, enrollment growth is expected to rise by 11.8 percent in 2014. In states choosing to not expand Medicaid, Kaiser’s survey found that enrollment is expected to grow by 5.3 percent on average.
  • Care Coordination Initiatives: Under the ACA, Medicaid programs can develop multiple approaches to coordinate care. The realignment of services is guided by a state’s implementation of newly developed integrated care models, known to most as Health Homes, Patient-Centered Medicaid Homes, and Accountable Care Organizations (ACOs). Kaiser’s analysis revealed that integrated care is being adopted rapidly, even in states not expanding Medicaid. Coordination initiatives are proving especially beneficial for behavioral health providers, as they reduce costs and improve beneficiaries’ overall health status. In total, 26 states indicated plans to implement or expand care coordination activities next year.
  • Reimbursement Changes: Kaiser’s survey revealed that improved state economies have also led to an increase in provider rates for the first time in several years. In fact, in 2013, 40 states increased provider rates. Forty-four states reported plans to increase at least one provider rate in 2014. In fact, 19 states will increase inpatient hospital rates, and 25 states are increasing Managed Care Organization rates.

Kaiser’s survey found that Medicaid directors are most concerned with coordinating their programs with the ACA insurance Marketplace in 2014 and beyond. Other challenges reported included: State financing budgets, development and implementation of payment and delivery system reforms, and obtaining the right work force talent to deal with evolving Medicaid policy and information technology expertise.

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