which states have not expanded medicaid

An American flag stands on display at a polling location in Sioux Falls, S.D., on Tuesday, June 2, 2020. Premiums are eliminated for those below 150 percent of FPL. To date, 10 states have resisted the coverage expansion offered by the Affordable Care Act. PDF What is the Result of States Not Expanding Medicaid? - Urban Institute "Instead, seek innovative free market solutions that disrupt traditional healthcare delivery models, increase competition, and lead to better health outcomes for Mississippians.". The main difference between options 2 and 3 is the improvement in cost-sharing subsidies and reinsurance. Following assumptions made in similar analyses by the Congressional Budget Office (CBO), we assume that 50 percent (or $0.9 billion) of uncompensated care savings will be realized as Medicare Disproportionate Share Hospital (DSH) savings; how the remainder of the reduction in the uncompensated care is realized is uncertain. I was like, oh wow," she says. Option 1 extends marketplace coverage to people earning less than the poverty level but does not improve premium and cost-sharing subsidies. With North Carolina lawmakers announcing they have reached a deal to expand Medicaid, that leaves 10 states that have not accepted the expansion . 6. There are savings to households of $4.0 billion, primarily reduced out-of-pocket costs. PDF Adult Coverage Expansion Map - Medicaid.gov Indiana and a couple of other states have implemented disenrollment and lockouts for premium nonpayment using Medicaid Section 1115 waivers. Lock "The legislators who would have to vote to make this possible would be ceding quite a bit of power to localities." These results show slightly higher Medicaid and CHIP coverage above 138 percent of FPL for the same reason. With Missouri now legally decided, 12 other states, mostly Republican-led, are still expansion holdouts and seem unlikely to budge, despite the roughly 11 years that have passed since the ACA was passed and 18 months into a global health pandemic. Our work is licensed under Creative Commons (CC BY-NC-ND 3.0). The COVER Now Act, introduced by Rep. Lloyd Doggett, D-Texas, would empower local jurisdictions to expand Medicaid. Table 3 shows the changes in nongroup and Medicaid coverage by income. Mike Parson in May declined to implement the unfunded program. Georgia 4. The first column shows these subsidies before the ARPAs enactment. But Republicans argue it is an overstep of the federal government into the free market, raising costs and threatening coverage quality. States That Have Expanded Medicaid Are Better Positioned to Address A federal government managed website by theCenters for Medicare & Medicaid Services.7500 Security Boulevard Baltimore, MD 21244, An official website of the United States government, Improving Care for Medicaid Beneficiaries with Complex Care Needs and High Costs, Promoting Community Integration Through Long-Term Services and Supports, Eligibility & Administration SPA Implementation Guides, Medicaid Data Collection Tool (MDCT) Portal, Using Section 1115 Demonstrations for Disaster Response, Home & Community-Based Services in Public Health Emergencies, Unwinding and Returning to Regular Operations after COVID-19, Medicaid and CHIP Eligibility & Enrollment Webinars, Affordable Care Act Program Integrity Provisions, Medicaid and CHIP Quality Resource Library, Lawfully Residing Immigrant Children & Pregnant Individuals, Home & Community Based Services Authorities, March 2023 Medicaid & CHIP Enrollment Data Highlights, Medicaid Enrollment Data Collected Through MBES, Performance Indicator Technical Assistance, 1115 Demonstration Monitoring & Evaluation, 1115 Substance Use Disorder Demonstrations, Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations, Seniors & Medicare and Medicaid Enrollees, Medicaid Third Party Liability & Coordination of Benefits, Medicaid Eligibility Quality Control Program, State Budget & Expenditure Reporting for Medicaid and CHIP, CMS-64 FFCRA Increased FMAP Expenditure Data, Actuarial Report on the Financial Outlook for Medicaid, Section 223 Demonstration Program to Improve Community Mental Health Services, Medicaid Information Technology Architecture, Medicaid Enterprise Certification Toolkit, Medicaid Eligibility & Enrollment Toolkit, SUPPORT Act Innovative State Initiatives and Strategies, SUPPORT Act Provider Capacity Demonstration, State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services, Early and Periodic Screening, Diagnostic, and Treatment, Vision and Hearing Screening Services for Children and Adolescents, Alternatives to Psychiatric Residential Treatment Facilities Demonstration, Testing Experience & Functional Tools demonstration, Medicaid MAGI & CHIP Application Processing Time, Medicaid Expansion Adult Enrollment by State, Medicaid Budget and Expenditure System (MBES) Enrollment September-December 2020. The Kaiser Family Foundation (KFF), which has been tracking Medicaid disenrollments since Congress and the Biden White House agreed late last year to begin unwinding pandemic-era coverage protections in April, estimates based on state data that more than 1.2 million people have been removed from the program in 21 states as of Thursday. The biggest are Texas, Florida, and Georgia, but there are a few outside the South, including Wyoming and Kansas. Federal Action Needed to Close Medicaid "Coverage Gap," Extend Coverage "We never got anything saying we were booted out of the system.". "As of November 2013, 20 states have decided to opt out of the Medicaid expansion," the report said. Status of State Medicaid Expansion Decisions: Interactive Map, New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending, Building on the Evidence Base: Studies on the Effects of Medicaid Expansion, February 2020 to March 2021, The Effects of Medicaid Expansion under the ACA: Studies from January 2014 to January 2020, Effects of the ACA Medicaid Expansion on Racial Disparities in Health and Health Care, The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid, Medicaid Expansion Enrollment and Spending Leading up to the COVID-19 Pandemic. The political and logistical challenges would be tough, policy analysts say. Because the pandemic has reduced use of expensive care, we assume costs for private nongroup health insurance and Medicaid are flat in 2021 but return to default inflation assumptions in 2022.20 Under our default assumptions, we estimate Medicaid will grow at 5 percent, and out-of-pocket spending and uncompensated care will grow at 3 percent; beyond 2022 we assume federal health spending for the nonelderly will grow at 4 percent. The independent source for health policy research, polling, and news. The Kaiser Family Foundation (KFF), which has been tracking Medicaid disenrollments since Congress and the Biden White House It brings new nongroup or Medicaid coverage to an additional 3.1 million individuals with incomes below 138 percent of FPL. That loss will be most acutely felt in the 10 states that have not expanded Medicaid eligibility, as allowed under the Affordable Care Act. The independent source for health policy research, polling, and news, KFF is a nonprofit organization based in San Francisco, California. Some states are even working to make changes to the Medicaid program, including buy-in programs and putting lifetime caps in place. One uses the pre-ARPA ACA subsidy schedule. No state has accepted expansion and then thrown it away. Option 2 is like option 1 but with enhanced premium subsidies. Then the program becomes very popular., We know Medicaid is a good investment, so why is it being blocked? In particular, there is a drop of 1.2 million in private nongroup coverage, mostly because of people with incomes between 100 percent and 138 percent of FPL switching to Medicaid from marketplace coverage. Privacy Policy, International Health Care System Profiles, Read the report to see how your state ranks, spur other nonexpansion states to reconsider, 2023 Scorecard on State Health System Performance, U.S. Supreme Court Preserves Medicaid Beneficiaries Rights, Medicaid Work Requirements Wouldnt Increase Employment and Could Imperil Future Labor Market Participation. Source:Medicaid Budget and Expenditure System (MBES) Enrollment September-December 2020. The number of people enrolled in Medicaid increases slightly, because when more people seek marketplace coverage, more family members eligible for Medicaid or the Childrens Health Insurance Program (CHIP) get enrolled. More than 1 million people have been dropped from Medicaid in the past couple months as some states moved swiftly to halt health care coverage following the end of the coronavirus pandemic. 1 As of this writing, 12 states have neither expanded Medicaid nor passed ballot initiatives to expand Medicaid as al. Total health spending in these states increases by $11.1 billion. "I'm stressed out about it. States that already expanded continue to enjoy budgetary savings in out-years, according to a 2016 analysis from the left-leaning Center on Budget and Policy Priorities. ) or https:// means youve safely connected to the .gov website. One million lose Medicaid coverage after pandemic protections expire - CNBC Non-Expansion. People who were under the poverty line were to be funneled to a newly-expanded version of Medicaid the public health insurance program that is jointly funded by states and the federal government. That sets up some moral dilemmas, and even those in favor of progressive policy to expand coverage are uncertain about what may come next. Residents will now be at a greater risk of losing their Medicaid coverage and not having affordable alternatives. Andrea Riquier reports on housing and banking from MarketWatch's New York newsroom. Logistically, such a plan would require counties and cities to create new infrastructure to run a Medicaid program, Rudowitz notes, and the federal government would have to oversee how well these new local programs complied with all of Medicaid's rules. As a result, it costs the federal government more to cover low-income people than under the other two options, which have greater cost sharing and premiums. "It was $74 [short]. These data are available in a table format. Eliminating the ACA: What Could It Mean for Medicaid Expansion? There are more than 2 million people across the United States who have no option when it comes to health insurance. "We never got anything saying we were booted out of the system.". All of these would be complicated to pull off. It doesnt matter what that means for vulnerable populations, or for geographic, racial and class-based equity.. When the public health emergency ends, an estimated 15 million people will lose their Medicaid coverage. Second, the more generous subsidies increase enrollment significantly for those above 100 percent of FPL, which increases the total cost of subsidies. To help improve maternal health and coverage stability and to help address racial disparities in maternal health, a provision in the American Rescue Plan Act of 2021 gives states a new option to. Total health spending in nonexpansion states increases by $12.2 billion. Individuals in states that have not expanded their Medicaid eligibility may suddenly find themselves in the coverage gap. This option not only extends assistance paying for coverage to those below 100 percent of FPL but also improves affordability for those throughout the income distribution. Opens in a new window. Status of State Medicaid Expansion Decisions: Interactive Map The model simulates household and employer decisions and models the way changes in one insurance market interact with changes in other markets. There are small increases in coverage at higher incomes, because the expansion of coverage for people below the poverty level positively affects the nongroup market risk pools, causing a small reduction in premiums that attract some additional enrollees. This offers a broad benefit package and has no or nominal cost sharing. The cost of filling the gap is higher if federal matching rates in nonexpansion states are increased for equity reasons and to prevent states from reversing their Medicaid expansions. Becerra sent the letter after Rep. Frank Pallone (D-N.J.) and Sen. Ron Wyden (D-Ore.) Oklahoma and Missouri are the most recent states to have expanded Medicaid, both doing so in 2021. 21. Many sought to address the challenges raised by the COVID-19 pandemic in this latest session, but where do they stand on Medicaid expansion? The biggest are Texas, Florida, and Georgia, but there are a few outside the South, including Wyoming and Kansas. Notes: Medicaid Expansion Enrollment includes Group VIII enrollees as of December 2020. But the Supreme Court made Medicaid expansion essentially optional in 2012, and many Republican-led states declined to expand. In his January State. To donate by check, phone, or other method, see our More Ways to Give page. The total of the three spending components is the same as reported earlier, but small amounts reported as cost-sharing reductions should have been attributed to premium tax credits. The ARPA includes an additional temporary financial incentive for states to expand Medicaid. Jacob Goldin, Ithai Z. Lurie, and Janet McCubbin, Health Insurance and Mortality: Experimental Evidence from Taxpayer Outreach, NBER Working Paper 26533 (National Bureau of Economic Research, Dec. 2019). "Don't simply cave under the pressure of Democrats and their allies in the media who are pushing for the expansion of Obamacare, welfare and socialized medicine," Reeves said. Of this, Medicare DSH payments fall by $1.8 billion; the distribution of the rest is unknown. Official websites use .gov What's next: Doggett introduced the bill earlier this month. Exhibit 3 and Table 5 show changes in spending for each option for 2022. A federal policy that extends marketplace subsidy eligibility below 100 percent of FPL may not be a complete substitute for Medicaid expansion. Unfortunately, in non-expansion states, including Texas, Florida, Georgia, and Tennessee, state lawmakers have taken the extended postpartum coverage extension but did not expand Medicaid to all adults-- a less effective strategy and more costly move overall, since the additional 10 months of postpartum coverage are matched at the state's . Trying to strangle local governments: What happens when states and their cities become adversaries? Wisconsin (has expanded to 100 percent of FPL) It is necessary to take a comprehensive look at Medicaid expansion spending offsets available to a given state to determine how that states spending under Medicaid expansion compares with state spending under one of the marketplace alternatives that we considered. "@RichMuny @fvckinashman @RealSasquatch3 @Inkling61 @SenTuberville Red states have NO problem rejecting federal funds to expand Medicaid so that premiums go down Obamacare recipients." About 1.5 million people have lost Medicaid coverage in more than two dozen states as a post . More than 1 million people are dropped from Medicaid as states start a post-pandemic purge of rolls. The overall expansion of enrollment in Medicaid is 6.2 million, but there is a decline in nongroup and employer coverage, leaving 5.0 million more people at all income levels with Medicaid or nongroup coverage. Option 3 increases federal spending in nonexpansion states by $27.9 billion, or $335 billion over 10 years. Under that scenario, federal spending increases by $34.6 billion, or $415 over 10 years. This could spur other nonexpansion states to reconsider their stance. GPB is committedto bringing you comprehensive news coverage from Georgia, across the country and around the world. Voters in that state approved Medicaid expansion last year, which is set to begin on July 1, 2021. But, so far publicly, at least no states have indicated they intend to take the federal government up on its offer. Texas 11. Some legal experts believe part of this requirement could be addressed through administrative action. The biggest are Texas, Florida, and Georgia, but there are a few outside the South, including Wyoming and Kansas. Enrollment in employer coverage drops by 379,000, as individuals use the enhanced subsidies to move to nongroup coverage. Sarah Huckabee Sanders is If the federal matching rate in expansion states were increased to 100 percent of FPL, federal spending would increase by another $12.1 billion; overall federal sending would increase by $27.2 billion, or $327 billion over 10 years. publicly bragging about the pace of her state's Medicaid purge. If the South Dakota measure is approved, Florida and Wyoming will be the only remaining nonexpansion states with the option of expanding Medicaid by ballot initiative. Those subsidies are, however, generally much lower than the cost of offering those people full Medicaid coverage. February 1, 2022 Expanding Health Coverage to the Poorest Residents of States That Have Not Expanded Medicaid A pedestrian walks down Manor Road on March 3, 2021, in Austin, Texas. InIn thethe 2424 statesstates thatthat havehave notnot expandedexpanded Medicaid,Medicaid, 6.76.7 millionmillion residentsresidents areare projectedprojected toto remainremain uninsureduninsured inin 20162016 asas aa result.result. The amounts are higher in Alaska and Hawaii. "I'm going to just have to pay it out of pocket or get on some payment plan until it all gets paid for.". Since there is no such employment-related test for Medicaid eligibility, Medicaid expansion makes more people in this income range eligible for affordable coverage. With the unwinding of Medicaid'scontinuous coverage requirement, up to 15 million Americans could lose their benefits over the next 12 months. It also might amplify geographic equity concerns, she says. Absent Medicaid expansion, the federal government could extend eligibility for premium tax credits and cost-sharing reductions to people below 100 percent of FPL, thereby covering the large majority of this group, at 100 percent federal cost. First, we aged the 2020 population to 2022 using projections from the Urban Institutes Mapping Americas Futures program. The uninsured rate among low-income, non-elderly adults in expansion states was 17 percent in 2019, roughly half of its 35 percent in 2013. We cannot afford to come up short. Essentially, the federal government will cover 90% of the costs of the newly eligible population, and an additional 5% of the costs of those already enrolled. The cost of increasing the federal match in expansion states increases these amounts to $344 billion, $352 billion, and $362 billion, respectively. In option 1 above, federal spending for people in the Medicaid gap increases by $16.6 billion as they become eligible for subsidies. Jesse Cross-Call, CBPPs director of state Medicaid strategy, and the author of that analysis, told MarketWatch that in addition to broader budget savings, state spending on Medicaid consistently grows more slowly in expansion states, and more quickly in non-expansion states. What's next: This idea was raised as a possible solution in a letter last month from Georgia's Democratic senators to Senate leaders, and Sen. Raphael Warnock said this week he plans to introduce legislation soon. Overall, the number of uninsured falls by 5.0 million, more than in option 2 because the cost-sharing subsidies are more generous. It's possible Democrats will include one of these ideas in a reconciliation bill that could pass without the threat of a Republican filibuster. Our Scorecard ranks every states health care system based on how well it provides high-quality, accessible, and equitable health care. Heres how you know. Ten states -- Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming -- have not accepted the Medicaid expansion. 3.7 Million People Would Gain Health Coverage in 2023 If the Remaining 12 States Were to Expand Medicaid Eligibility | Urban Institute Skip to main content Sort by What's next: Doggett introduced the bill earlier this month. See Brendan Saloner et al., Access to Care Among Individuals Who Experienced Medicaid Lockouts After Premium Nonpayment, JAMA Network Open 2, no. Medicaid Postpartum Coverage Extension Tracker | KFF Option 2, which extends ACA coverage to people with incomes below 100 percent of FPL and also expands premium subsidies throughout the income distribution, covers 4.6 million more individuals in nonexpansion states than under current law with pre-ARPA subsidies. What's Next: When asked about progress on this front in an April press briefing, Biden's press secretary Jen Psaki said "the President is certainly supportive of and an advocate for states expanding Medicaid," but did not answer a follow up about whether the White House was directly reaching out to governors regarding this option. Medicaid Expansion: Frequently Asked Questions Lawfully present individuals in these states with incomes above 100 percent of FPL ($12,880 for an individual and $26,500 for a family of four in 2021) can use premium tax credits and cost-sharing reductions to obtain ACA marketplace coverage, provided no family member has an offer of coverage deemed affordable under the law. Over the two years that HCA's board has used mortality rates to calculate incentive pay, Samuel N. Hazen, HCA's chief executive, received $35.3 million in total compensation. As Auxier put it, No state has accepted expansion and then thrown it away. "That can be quite complex to implement a federal program that's targeted to just these 2.2 million people across a handful of states," says Robin Rudowitz, co-director of the Medicaid program at the Kaiser Family Foundation, who wrote a recent analysis of the policy options. HIPSM is a detailed microsimulation model of the health care system designed to estimate the cost and coverage effects of proposed health care policy options. But we find that it would provide comprehensive coverage to millions of low-income people in nonexpansion states who would otherwise be left uninsured. sent a letter to the governor of every U.S. state expressing concern over the "high number of people losing coverage due to administrative processes" and reminding officials that they "must comply with federal rules regarding how they conduct" Medicaid renewals, including affording due process to those kicked off the program. Exhibit 2 and Table 4 show the reduction in the uninsured (including the insured who leave noncompliant plans) by income level. Earlier this week, Health and Human Services Secretary Xavier Becerra Yes, I also want to receive the CNET Insider newsletter, keeping me up to date with all things CNET. Given these dynamics, expansion will continue to be an issue to watch in state legislative sessions in 2023 and beyond. The success of Republican leadership in North Carolina to advance expansion bills in both chambers, combined with favorable views of Medicaid and the ARPA financial incentive, could make Medicaid expansion seem like a more politically viable option. In Republican-led Florida, the state with the most disenrollments thus far at close to 250,000, some residents say they've been removed from Medicaid without receiving any notice from the government, finding out about their lack of coverage only when they attempted to schedule a doctor's appointment or pick up a prescription. While Medicaid may be more appropriate coverage for some people than marketplace coverage, the latter is still clearly superior to being uninsured. 20. While states see $5.2 billion in new Medicaid spending because of required matching payments offset somewhat by lower spending on uncompensated care this does not take into account important savings to state governments. HIPSM is based on two years of the American Community Survey, which provides a representative sample of families large enough for us to produce estimates for individual states and smaller regions, such as cities. The Affordable Care Acts (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($20,120 for an individual in 2023) and provided states with an enhanced federal matching rate (FMAP) for their expansion populations. Those states already have higher uninsured rates and more hospital closings, according to a report by theCommonwealth Fund. Under the terms of the 2010 Affordable Care Act, the federal government contributes more generous funding to states that offer expanded access to the program to their residents. Bernard J. Wolfson, Covered California Announces Record-Low Rate Hike for 2021, California Healthline, Aug. 4, 2020; and New York State Department of Financial Services, DFS Announces 2021 Health Insurance Premium Rates, Protecting Consumers During COVID-19 Pandemic, press release; Aug. 13, 2020.
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