Medicaid is the biggest health care program in the country. It’s an important part of the United States health care system. But a lot of the information out there about Medicaid and attempts to change it can be difficult to understand and navigate. That’s why ASAN is proud to announce the release of our plain language resource “A Self-Advocate’s Guide to Medicaid.” This resource was developed in collaboration with the Autism Services, Education, Resources and Training Collaborative (ASERT), and with funding from the Special Hope Foundation.
The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review | The Henry J. Kaiser Family Foundation
Coverage: Studies show that Medicaid expansion results in significant coverage gains and reductions in uninsured rates, both among the low-income population broadly and within specific vulnerable populations.
Access to care, utilization, affordability, and health outcomes: Most research demonstrates that Medicaid expansion positively impacts access to care, utilization of services, the affordability of care, and financial security among the low-income population. Studies have also shown improved self-reported health following expansion, but additional research is needed to determine effects on health outcomes.
Economic measures: Analyses find positive effects of expansion on multiple economic outcomes, despite Medicaid enrollment growth initially exceeding projections in many states. Studies also show that Medicaid expansions result in reductions in uncompensated care costs for hospitals and clinics as well as positive or neutral effects on employment and the labor market.
As the Trump Administration and Congress debate ACA repeal and replacement, gains in coverage and access as well as economic benefits to states and providers are at stake if the Medicaid expansion is repealed.
Research on the effects of Medicaid expansions under the Affordable Care Act (ACA) can help increase understanding of how the ACA has impacted coverage; access to care, utilization, affordability, and health outcomes; and various economic outcomes, including state budgets, the payer mix for hospitals and clinics, and the employment and labor market. Understanding these findings can help inform the debate over a repeal of the ACA (which would include the Medicaid expansion).
This summary reviews findings from 108 studies of the impact of state Medicaid expansions under the ACA published between January 2014 (when the coverage provisions of the ACA went into effect) and January 2017. (This is an update to an earlier issue brief, “The Effects of Medicaid Expansion under the ACA: Findings from a Literature Review,” that covered studies published through May 2016.) It includes peer-reviewed studies as well as free-standing reports, government reports, and white papers published by research and policy organizations, using data from 2014 or later. This brief only includes studies that examine impacts of the Medicaid expansion; it excludes studies on impacts of ACA coverage expansions generally (not specific to Medicaid expansion alone) and studies investigating potential effects of expansion in states that have not (or had not, at the time of the study) expanded Medicaid. In both the brief below and the tables, findings are separated into three broad categories: Medicaid expansion’s impact on coverage; access to care, utilization, affordability, and health outcomes; and economic outcomes for the expansion states.
In a companion piece to Background to Medicaid and Section 1115 of the Social Security Act, Legal Director Jane Perkins and Managing Attorney of the DC office Mara Youdelman provide a brief review of how certain Medicaid requirements may be waived. They conclude, in part, that “Section 1115 of the Social Security Act gives the Secretary of HHS limited authority to approve Medicaid waivers.”
Medicaid’s guaranteed-enrollment for those who meet eligibility requirements makes the program vulnerable to attacks at both the federal and state levels. NHeLP actively defends Medicaid against these threats, protects the rights of beneficiaries to receive the services to which to which they are legally entitled and works to ensure that states meet their obligations under the Medicaid Act.
NHeLP’s Protect Medicaid Webinar Series
Proposals to drastically cut federal Medicaid spending through per capita caps and block grants would fundamentally alter and undermine Medicaid. NHeLP’s Protect Medicaid webinar series examines the harmful impact of these proposals on key features of the Medicaid program, including: services and benefits geared for vulnerable populations; affordability and cost sharing protections; advances under the ACA’s low income adult expansion; and consumer protections and due process guarantees.
Click the links to watch the videos, which will appear in a new window.
Click to download PDFs:
Click on the links below to register for these upcoming webinars:
Friday, April 7
Noon-1 p.m. EDT – Section 1115 authority
Friday, April 28
2 p.m. EDT – Rulemaking, Agency Authority, and the Administrative Procedures Act – An Overview
This NHeLP fact sheet provides information about health services for children, under age of 21, in schools. Many of the services are provided in schools, and some these services are provided Medicaid and/or the Individuals with Disabilities Education Act, or IDEA.
DOWNLOAD PUBLICATION (IDEA – Health Services in Schools – 1 Pager)
Health services in schools.
- Services provided in schools can play an important role in child and adolescent health care.
- Many services are already provided in schools: through school-based health clinics, school nurses, or through special education programs. This includes services such as mental health services and physical, occupational, and speech therapies.
- Some of these services can be covered by Medicaid.
- Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
Medicaid services for children.
- Medicaid requires that children under age 21 get Early and Periodic Screening, Diagnostic, and Treatment services, or EPSDT.
- EPSDT covers screenings (checkups) and treatment for medical, mental health, dental, vision, and hearing problems.
- Treatment includes services that can provided in schools, like:
Physical, occupational, and speech therapy.
Hearing and vision screenings.
Behavioral health services.
In the fourth paper in our “What Makes Medicaid, Medicaid?” series, NHeLP experts explain the provisions and protections that ensure Medicaid beneficiaries gain access to quality health care services. Senior Attorney Abigail Coursolle, Senior Policy Analyst David Machledt, and Senior Attorney Wayne Turner write, “Medicaid is designed to include many protections that ensure that beneficiaries get more than a coverage card. Medicaid ensures that beneficiaries have access to a range of services specifically designed for their needs.”
- Under current law, states have tremendous flexibility in designing their Medicaid programs to determine low-income people eligible and enroll them in coverage.
- Medicaid operates efficiently by ensuring that low-income people are enrolled into coverage when they need it.
- Medicaid coverage is designed to provide continuous coverage for pregnant women and newborns.
- Medicaid ensures that beneficiaries can get to their medical and specialty care appointments through transportation assistance.
- Medicaid contains protections designed to get beneficiaries who need prescription medication access to their treatment quickly.
- Medicaid gives beneficiaries the right to access the providers they need to treat their health conditions.
Legal Director Jane Perkins, and Policy Analyst Ian McDonald detail why adding a work requirement to Medicaid is “legally suspect.” They explain that currently the Medicaid Act has four requirements that an individual must meet that do not include a mandatory work requirement. “A number of courts,” Perkins and McDonald write, “have recognized that states may not ‘add additional requirements for Medicaid eligibility’ that are not set forth in the Medicaid Act.” They also note that the purpose of Medicaid is to “furnish medical assistance to low-income individuals who cannot afford the costs of medically necessary services and to furnish ‘rehabilitation and other services to help [such individuals] attain or retain capability for independence or self-care. A mandatory work requirement is not medical assistance; it is not a service provided to Medicaid beneficiaries.”
Executive SummaryIn an effort to win conservative members’ support for the Affordable Care Care Act repeal bill, House Republicans have added a work requirement for Medicaid to the measure. In this issue brief, NHeLP Managing Attorney of the DC office Mara Youdelman, Legal Director Jane Perkins, and Policy Analyst Ian McDonald detail why such work requirements “run counter to the purpose of Medicaid.” They conclude, “Work requirements would stand Medicaid’s purpose on its head by creating barriers to coverage and the pathway to health that the coverage represents.”DOWNLOAD PUBLICATION