States are considered “laboratories of democracy,” allowing experimentation with innovative reforms that could potentially be adopted at the national level. To test new approaches in their Medicaid programs, states have embraced Section 1115 waivers, which permit innovations that do not meet federal program rules, but still promote the program’s objectives.
Lack of transportation has been an enduring barrier to care, especially for low-income and rural patients. Many of these patients are covered by Medicaid, which, since 1966, has provided non-emergency transportation (NEMT) to medical appointments for free or at a heavily subsidized rate. Although NEMT is built into the foundation of Medicaid, some state governments are seeking leeway to drop that benefit. The movement stems from persistent budget constraints and a view that NEMT is ineffective.
Supply of Primary Care Providers and Appointment Availability for Philadelphia's Medicaid Population
This brief analyzes the supply of primary care providers serving the Medicaid population in Philadelphia, and the geographic variability of this measure across the city. It also examines important measures of access – appointment availability and wait time for an initial appointment – that highlight challenges faced by Medicaid patients.
Following Medicaid expansion in Pennsylvania in 2015, more than one in five non-elderly adults in Philadelphia are now covered by Medicaid. This population faces unique challenges with accessing primary care, including fewer providers accepting Medicaid patients.
In a recent Scattergood Foundation report, LDI Senior Fellow Dominic Sisti and I tackle the curious case of the “institutions for mental diseases” (IMD) exclusion in Medicaid. For non-elderly adults, the national IMD exclusion prevents Medicaid from paying for inpatient care in institutions with more than 16 beds that primarily provide care for persons with “mental diseases” other than dementia or intellectual disabilities.
On November 1st, the sixth year of open enrollment on the ACA Marketplace will start. While the basic rules that govern the Marketplace and the sliding-scale subsidies remain intact, gains in enrollment are unlikely given the end of penalties for the individual mandate, the emergence of association health plans, and new rules related to “short-term limited duration.”
Abstract [from journal]
We study spillover effects of the largest ever increase in Medicaid primary care reimbursement rates on behavioral health and healthcare outcomes; mental illness, substance use disorders, and tobacco product use. Much of the variation in Medicaid reimbursement rates we leverage is attributable to a large federally mandated increase between 2013 and 2014 through the Affordable Care Act. We apply differences-in-differences models to survey data specifically designed to measure behavioral health outcomes over the period 2010 to 2016. We find that higher...
The adequacy of “narrow network” plans offered on the Affordable Care Act (ACA) Marketplaces continues to be a concern in the wake of exclusions of some high-cost providers and the incidence of “surprise medical bills” even in facilities that are in-network.
The evidence on the positive effects of Medicaid expansion on coverage, access, utilization, and financial security is substantial and growing.
Medicaid’s federal-state partnership structure has long permitted states to adopt modifications to coverage design, including benefits and cost-sharing. That structure, combined with an Administration signaling its support for greater state flexibility and funding constraints, could produce substantial shifts in state Medicaid policy.
A survey of state legislators revealed clear partisan differences in Medicaid reform priorities and policy preferences that states are pursuing in Section 1115 waiver applications. While there was some agreement across parties on broad goals for the Medicaid program, such as reducing health care spending and increasing affordability of health care, there was little consensus on specific policy changes needed to meet these goals.