What changes are happening to Medicaid (Medical Assistance Program)?

Current Changes to Medicaid

Medicaid is undergoing significant transformations in eligibility, enrollment processes, and service integration to improve access to care and health outcomes for vulnerable populations. 1 These changes are critical for reducing morbidity and mortality and improving quality of life for beneficiaries.

Unwinding of Pandemic-Era Continuous Coverage

• States resumed Medicaid eligibility redeterminations in 2023 after the continuous coverage provision during the COVID-19 pandemic ended, resulting in approximately 12.5% of adult beneficiaries losing coverage 2
• About half (47.8%) of adults who lost Medicaid coverage became uninsured, while 27% transitioned to employer-sponsored insurance 2
• Loss of Medicaid coverage is significantly associated with delayed care due to cost and worsened affordability of care, directly impacting health outcomes 2
• Children experienced lower rates of disenrollment (5.4%) compared to adults 2

Medicaid Expansion Under the Affordable Care Act

• 38 states and Washington, DC have expanded Medicaid under the Affordable Care Act, leading to improved coverage, increased federal revenues, and better healthcare access 3

• Medicaid expansion states have experienced:

  • 22.7 percentage-point reduction in uninsured rates compared to non-expansion states 4
  • 12.1 percentage-point increase in access to primary care 4
  • 11.6 percentage-point reduction in skipped medications due to cost 4
  • 29.5% reduction in out-of-pocket spending 4
  • 6.0 percentage-point reduction in emergency department visits 4
  • Increased preventive care, including diabetes screening (6.3 percentage points) and regular care for chronic conditions (12.0 percentage points) 4

• Emergency department visits decreased by 4.7 visits per 1000 population in expansion states, primarily for non-emergent and primary care treatable conditions 5

Service Integration and Care Management

• States are implementing Medicaid managed long-term care service integration with specific provisions to address the needs of vulnerable populations, such as those with Alzheimer's disease 1
• Recommendations for these programs include:
  • Involving all stakeholders when developing Medicaid long-term plans 1
  • Including provisions to identify and address the needs of specific vulnerable populations 1
  • Informing recipients about various acute and long-term care service options 1
  • Incorporating quality assurance provisions, including trained providers and evidence-based guidelines 1

Telehealth Policy Changes

• Medicaid programs in all 50 states and DC now provide some form of reimbursement for telehealth care 1
• Many states have adopted Medicare-like changes to enable continuity of care, including:
  • Eliminating geographic restrictions for telehealth services 1
  • Expanding coverage for video-based telehealth, remote monitoring, and store-and-forward services 1
  • Addressing interstate licensure barriers through initiatives like the Interstate Medical Licensure Compact, now available in 29 states 1

Children's Health Insurance Program (SCHIP) Improvements

• Policy recommendations for SCHIP (which works alongside Medicaid) include:
  • Establishing performance-based outreach funds to reward states successful in enrolling eligible uninsured children 1
  • Improving administrative simplification for enrollment and reenrollment 1
  • Granting states flexibility to automatically enroll children based on participation in other means-tested programs 1
  • Encouraging presumptive eligibility for children during the enrollment process 1
  • Adopting 12-month continuous eligibility for enrolled children 1

Payment and Provider Network Enhancements

• More generous state Medicaid reimbursement rates are associated with improved care quality, particularly in nursing homes 1
• Recommendations include:
  • Establishing payment rates for pediatric services at least equal to Medicare RBRVS rates 1
  • Ensuring adequate payment for new vaccines and technologies 1
  • Adopting financial incentives for medical homes, especially for children with special needs 1
  • Providing financial incentives for practices that adopt quality-performance goals 1

Challenges and Pitfalls

• Wide state variation exists in Medicaid implementation, with some states still not expanding Medicaid, creating coverage gaps for vulnerable populations 6, 3
• Disenrollment during the unwinding process is higher among younger adults, employed individuals, and rural residents 2
• Racial and ethnic disparities persist within Medicaid, with approximately 56.4% of beneficiaries coming from racial and ethnic minority groups 3
• Despite expanded coverage, gaps remain in provider participation due to low reimbursement rates, which can limit access to care 1

Future Directions

• Additional policy reforms are needed to reduce health disparities by race and ethnicity within Medicaid 3
• Expanding Medicaid in remaining states would significantly improve coverage and health outcomes 3, 4
• Addressing disparities within Medicaid and focusing explicitly on equity in managed care and delivery system reforms represent opportunities to advance health equity 3