How many states have not adopted the ACA provision to expand Medicaid?
As of February 2021, 12 states have not adopted the Affordable Care Act (ACA) provision to expand Medicaid to adults with incomes through 138% of poverty. Millions of people in these states remain without an affordable coverage option.
What is the Affordable Care Act Medicaid expansion?
Affordable Care Act Medicaid Expansion 7/1/2021 Medicaid—a federal/state partnership with shared authority and financing—is a health insurance program for low-income individuals, children, their parents, the elderly and people with disabilities. Medicaid pays for health care for more than 74.5 million people nationally.
What changes did the ACA make to Medicaid?
The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) made a number of changes to Medicaid. Perhaps the most widely discussed is the expansion of eligibility to adults with incomes up to 133 percent of the federal poverty level (FPL). 1
Will CMS pay for Georgia’s Medicaid expansion?
As part of the waiver proposal, Georgia asked CMS to provide the state with full Medicaid expansion funding (i.e., covering 90 percent of the cost), despite the fact that the state would only be implementing a partial expansion of Medicaid.
Why does enrollment in Medicaid typically increase during times of economic downturn quizlet?
During economic downturns, unemployment rates go up and incomes fall which means demand for public safety-net programs, like Medicaid, go up.
Why does enrollment in Medicaid typically increase during times of economic downturn?
First, program enrollment usually increases when job and income losses cause more people to become eligible for Medicaid. Second, states generally have more difficulty financing the state share of Medicaid expenditures because state revenue growth tends to weaken during economic downturns.
Does Medicare increase reimbursement?
The MedPAC report, sent to Congress on March 15, 2022, recommended that federal officials maintain Medicare reimbursement rates for physicians and not provide any increases for 2023.
What was the enhanced federal match rate FMAP that was set out in the Affordable Care Act?
Increased FMAP rates through the Affordable Care Act The newly eligible FMAP is 100 percent in calendar years 2014-2016, 95 percent in calendar year 2017, 94 percent in calendar year 2018, 93 percent in calendar year 2019, and 90 percent in calendar years 2020 and beyond.
How did the great recession affect Medicaid?
The regression analysis suggests that the 6.4-percentage-point increase in the state unemployment rate during the recession led to a 5.8% increase in ALL Kids enrollment, a 27.5% increase in Medicaid enrollment, and a 23.7% increase in combined enrollment.
How did the great recession affect Medicare?
Examining this decline by year, we found that the economic downturn had no effect on Medicare spending through 2009 but meaningfully lowered spending growth from 2009 to 2012 by approximately $4 billion. That amounted to 1.6 percent of Medicare spending in our sample.
Did Medicare reimbursement go up in 2022?
This represents a 0.82% cut from the 2021 conversion factor of $34.8931. However, it also reflects an increase from the initial 2022 conversion factor of $33.5983 announced in the 2022 Medicare physician fee schedule final rule.
Are Medicare reimbursements tied to inflation?
A feature of each payment system is an annual adjustment reflecting rising input costs, as measured by “market baskets” created specifically for the various provider groupings. Thus, as inflation rises, so too do the base payments for a wide array of Medicare-covered services.
What is the 2022 conversion factor?
$34.6062In implementing the Act, the Centers for Medicare & Medicaid Services (CMS) updated the 2022 Medicare physician fee schedule conversion factor to $34.6062. The initial 2022 final rule provided a reduced conversion factor of $33.59.
How is the FMAP calculated?
The first is the actual amount spent that qualifies as matchable under Medicaid and the FMAP. The Federal Medical Assistance Percentage (FMAP) is computed from a formula that takes into account the average per capita income for each State relative to the national average. By law, the FMAP cannot be less than 50%.
What is the difference between FMAP and FFP?
Federal financial participation (FFP) means the Federal Government's share of a State's expenditures under the Medicaid program. FMAP stands for the Federal medical assistance percentage, which is used to calculate the amount of Federal share of State expenditures for services.
Under which program does the federal government send Medicaid funding to states?
The Medicaid program is jointly funded by the federal government and states. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP).
What is the Affordable Care Act?
Medicaid—a federal/state partnership with shared authority and financing—is a health insurance program for low-income individuals, children, their parents, the elderly and people with disabilities. Medicaid pays for health care for more than 74.5 million people nationally.
Do all states have to meet the federal minimum requirements for Medicaid?
However, eligibility for Medicaid benefits varies widely among the states - all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guidelines, the details are outlined here.
Is Medicaid expansion a waiver?
A number of states implemented Medicaid expansion through an approved Section 1115 Waiver. For more information on Medicaid waivers click here.
Why is Texas refusing to expand Medicaid?
By refusing Medicaid expansion under the ACA, Texas has already missed out on billions in federal funding that would otherwise have flowed to the state to provide medical care for their low-income residents. And in addition, the state’s emergency rooms are providing $5.5 billion in uncompensated care each year, treating patients who don’t have health insurance. If Medicaid eligibility had been expanded, uncompensated care would have dropped considerably, so hospitals and business groups across the state have been pressuring lawmakers to relent on their opposition to Medicaid expansion.
How many people are in the Medicaid coverage gap in Texas?
759,000 people are in the coverage gap in Texas. Non-disabled, non-pregnant adults only eligible if they have a minor child and earn less than 14% of the poverty level. Texas Medicaid enrollment has only grown by 3% since 2013. The state is missing out on billions in federal funding by not expanding Medicaid.
How does Medicaid provide financial assistance to Medicare beneficiaries in Texas?
Many Medicare beneficiaries receive Medicaid’s help with paying for Medicare premiums, affording prescription drug costs, and covering expenses not reimbursed by Medicare – such as long-term care.
How to apply for medicaid in Texas?
If you believe you may be eligible to enroll in Medicaid in Texas: 1 You can enroll through HealthCare.gov, either online or by phone at 1-800-318-2596. (Use this option if you’re under 65 and don’t have Medicare.) 2 You can enroll through the Medicaid website maintained by the Texas Health and Human Services Commission. 3 You can also download and print a paper application, or request that one be mailed to you, by using this page on the Texas Medicaid website.
What percentage of poverty is Medicaid?
As the ACA was written, it called for Medicaid expansion in every state for legally present residents with incomes up to 133 percent of poverty (138 percent, with the built-in 5 percent income disregard).
How much is uncompensated care in Texas?
Uncompensated care: $25 billion in federal funding. Political leaders in Texas have remained mostly uninterested in expanding Medicaid. Instead of pushing for legislation to expand Medicaid, Texas officials negotiated with CMS in an effort to secure ongoing funding to cover uncompensated care in the state.
What is the highest uninsured rate in the US?
According to U.S. Census data, 22.1 percent of Texas residents were uninsured in 2013. It stood at 17.7 percent in 2018, which was still the nation’s highest uninsured rate.
When will the 6.2 percent increase in Medicaid be in place?
Based on a January 2021 letter from the Biden Administration to Governors, the 6.2 percentage point increase in the match will be in place at least through March 2022, halfway through federal FY 2023. While the enhanced match would be in place for two years after a state implements the Medicaid expansion, states can take advantage ...
How many states have not adopted the ACA?
New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending. As of February 2021, 12 states have not adopted the Affordable Care Act (ACA) provision to expand Medicaid to adults with incomes through 138% of poverty. Millions of people in these states remain without an affordable coverage option.
What is the American Rescue Plan Act of 2021?
The American Rescue Plan Act of 2021 encourages non-expansion states to take up the expansion by providing an additional temporary fiscal incentive for states to newly implement the ACA Medicaid expansion. This brief provides illustrative estimates of the net fiscal benefit to states from these incentives relative to state costs under the expansion.
How does Medicaid expansion affect the uninsured?
A comprehensive literature review of Medicaid expansion studies shows that expansion helps to expand coverage and reduce the uninsured, improve access to and utilization of care, reduce uncompensated care costs, improve affordability of care and reduce racial and ethnic disparities in coverage. The provisions in the American Rescue Plan Act would also provide substantial fiscal incentives for states to expand, which could be attractive given recent state revenue declines. However, given that the expansion incentive would be temporary, its effect may be limited.
How long will the federal government continue to fund the 10% expansion?
These estimates do not include additional federal funds that states would draw down through the 90% federal match on expansion spending, which would continue as long as the expansion is in place. States would continue to fund the 10% share of expansion and would lose the added fiscal incentive after two years.
How many states have not adopted the Affordable Care Act in 2021?
Published: Mar 17, 2021. Issue Brief. Methodology. Endnotes. As of February 2021, 12 states have not adopted the Affordable Care Act (ACA) provision to expand Medicaid to adults with incomes through 138% of poverty. Millions of people in these states remain without an affordable coverage option. Currently, the federal government covers 90% ...
What are the provisions of the American Rescue Plan Act?
The provisions in the American Rescue Plan Act would also provide substantial fiscal incentives for states to expand , which could be attractive given recent state revenue declines. However, given that the expansion incentive would be temporary, its effect may be limited.
How much did Medicaid spend on expansion states?
Spending on the traditional Medicaid population was much higher: $347.6 billion in expansion states (79% of total spending) and $500.8 billion across all states (84% of total spending). This difference in spending is partially explained by the greater number of traditional enrollees compared to expansion enrollees.
When did Maine expand Medicaid?
Expansion enrollment ranged from a high of 48% of total enrollment in Oregon to a low of 11% in Maine, which implemented Medicaid expansion coverage in the second quarter of FY 2019 (January 2019), although Maine allowed for retroactive enrollment as early as July 2018.
How many people are covered by Medicaid in 2019?
In total, Medicaid enrollment for FY 2019 was 75.2 million individuals across all 50 states and DC, with 15.3 million adults enrolled in the expansion group. Within the expansion group, most (81%, 12.5 million) were newly eligible enrollees covered through Medicaid expansion, while a smaller share (19%, 2.9 million) were not newly eligible enrollees (childless adults who were enrolled through state waivers prior to passage of the ACA). The majority of Medicaid enrollment overall (80%, 59.8 million) was within the traditional Medicaid group, which is composed of several different eligibility groups (see Box 1 above for more information). These groups are subject to varying eligibility levels across states, with children and pregnant women generally covered at much higher eligibility levels compared to non-expansion parents and seniors and people with disabilities.
How much is Medicaid for 2020?
In states that have implemented the Medicaid expansion (which was made effectively optional by the Supreme Court ruling on the ACA’s constitutionality ), nearly all adults under age 65 and with incomes at or below 138% of the FPL ($17,609 per year for an individual in 2020) are eligible for Medicaid.
How much of Medicaid spending was in 2019?
Spending on the expansion group represented 16% of all Medicaid spending in FY 2019 and was primarily federal funds.
What is a traditional Medicaid group?
Further, the traditional Medicaid group is composed of many different eligibility groups, including groups with smaller enrollment levels but higher per-enrollee spending such as seniors and people with disabilities (for more details, see Per Capita Spending section below).
What is the FMR for fiscal year?
Fiscal Year Expenditures: Expenditure totals for states are extracted from annual Financial Management Reports (FMR). National totals represent the sum of state totals.
What would happen if Georgia expanded Medicaid?
It’s also noteworthy that if Georgia were to fully expand Medicaid as called for in the ACA, the state would be guaranteed to receive 90 percent federal funding (i.e., no waiver approval necessary), and an estimated 400,000 to 500,000 people would gain coverage. Instead, the state is moving forward with a plan that will cover only a fraction of those individuals, and they’re forfeiting the enhanced federal funding match that would be provided if they fully expanded Medicaid. It’s also likely that the work requirement will face the same legal challenges that have hindered similar programs in other states.
When did Medicaid start in Georgia?
The federal legislation authorizing Medicaid was enacted in 1965, and Georgia implemented its program in October of 1967. The Georgia Medicaid program is managed by the Georgia Department of Community Health (DCH).
Who is eligible for Medicaid in Georgia?
As of April 2020, criteria for enrollment in Georgia Medicaid are set at the following levels for non-disabled adults:
What are the eligibility requirements for Medicaid in Georgia?
As of April 2020, criteria for enrollment in Georgia Medicaid are set at the following levels for non-disabled adults: 1 Children up to age 1 with family income up to 205 percent of FPL 2 Children ages 1-5 with family income up to 149 percent of FPL 3 Children ages 6-18 with family income up to 133 percent of FPL 4 Pregnant women with family income up to 220 percent of FPL 5 Parents of minor children with family income up to 35 percent of FPL
How much does Georgia Pathways cost?
The premiums will range from $7 to $11/month, with a lower additional rate for a spouse, plus a tobacco surcharge if applicable. Members will also be able to earn reward points for certain healthy behaviors and use the points to receive dental and vision care, over the counter drugs, and to cover copays for medical care.
How many people in Georgia are uninsured in 2020?
As of May 2020, 23 percent of Georgia residents were uninsured — the state has the fourth highest uninsured rate in the U.S. Georgia is leaving billions of dollars on the table and nearly half a million people without Medicaid coverage by passing up federal funding to expand Medicaid.
What is the difference between HB 943 and HB 990?
Two laws designed to make expansion difficult were enacted during the 2014 legislative session. HB 990 prohibits Medicaid expansion without legislative approval (the 2019 legislation that triggered the Georgia Pathways proposal expressly allows for Medicaid expansion for those earning up to the poverty level), while HB 943 prohibits state and local employees from advocating for Medicaid expansion.
How much is the Medicare shortfall?
This includes a shortfall of $56.8 billion for Medicare and $19.0 billion for Medicaid. For Medicare, hospitals received payment of only 87 cents for every dollar spent by hospitals caring for Medicare patients in 2019. For Medicaid, hospitals received payment of only 90 cents for every dollar spent by hospitals caring for Medicaid patients in 2019.
How are Medicare and Medicaid payments reported?
Gross charges for these services are then translated into costs. This is done by multiplying each hospital’s gross charges by each hospital’s overall cost-to-charge ratio, which is the ratio of a hospital’s costs (total expenses exclusive of bad debt) to its charges (gross patient and other operating revenue).
What is underpayment in healthcare?
Underpayment occurs when the payment received is less than the costs of providing care, i.e., the amount paid by hospitals for the personnel, technology and other goods and services required to provide hospital care is more than the amount paid to them by Medicare or Medicaid for providing that care.
What is the AHA?
Each year, the American Hospital Association (AHA) collects aggregate information on the payments and costs associated with care delivered to beneficiaries of Medicare and Medicaid by U.S. hospitals.
Is Medicare voluntary for hospitals?
Hospital participation in Medicare and Medicaid is voluntary. However, as a condition for receiving federal tax exemption for providing health care to the community, not-for-profit hospitals are required to care for Medicare and Medicaid beneficiaries. Also, Medicare and Medicaid account for more than 60 percent of all care provided by hospitals.
Is Medicare underpayment voluntary?
Hospital participation in Medicare and Medicaid is voluntary. However, as a condition for receiving federal tax ...
Is Medicare and Medicaid bridging the gaps?
Bridging the gaps created by government underpayments from Medicare and Medicaid is only one of the benefits that hospitals provide to their communities. In a separate fact sheet, AHA has calculated the cost of uncompensated hospital care (financial assistance and bad debt), which also are benefits to the community.
What is the goal of the Affordable Care Act?
Decreasing health care expenditures has been one of the main objectives of the Affordable Care Act. To achieve this goal, the Centers for Medicare and Medicaid Services (CMS) has been tasked with experimenting with provider reimbursement methods in an attempt to increase quality, while decreasing costs. The purpose of this research was ...
Why has CMS experimented with payment methods?
The CMS has experimented with payment methods in an attempt to increase cost-effectiveness. Medicare has offered shared cost-savings incentives to reward quality care to both primary care providers and preventative services.