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Study Finds Surprise in Sources of Medicaid, CHIP Growth

While enrollment in Medicaid and CHIP has been greatest among low-income families working full-time for small businesses, growth in Medicaid and CHIP enrollment among low-income families employed full-time by big businesses has been rising faster in recent years.

According to a new study published in the journal Health Affairs, Medicaid and CHIP enrollment among low-income families employed full-time by large companies rose from 45 percent to 69 percent between 2008 and 2016.  The driving force behind this growing reliance on public insurance appears to be the shift of health insurance costs from companies to employees:  employee share of health insurance premiums rose 57 percent during that same period, leaving many families unable to afford even employer-subsidized health insurance.

Learn more about the growing Medicaid and CHIP participation rates among different economic groups in the Health Affairs report “Growth Of Public Coverage Among Working Families In The Private Sector.”

Bureaucratic Requirements May Be Driving Medicaid Enrollment Decline

State eligibility redetermination processes may be pushing down Medicaid enrollment nation-wide.

Last year, national Medicaid enrollment fell 1.5 million, more than half of them children, and according to a new report from Families USA, much of that decline may be attributable to the challenging eligibility redetermination requirements imposed on Medicaid-eligible individuals by some states.

Those requirements include a 98-page packet that Tennessee sends to individuals seeking to retain their Medicaid eligibility; Arkansas’ limit of 10 days to respond to requests for information to redetermine eligibility; and Missouri’s decision to discontinue using data from other public safety-net programs to redetermine eligibility.

Others point to an improving national economy and new Medicaid work requirements as the primary causes of declining Medicaid enrollment.

Declining Medicaid enrollment can be especially challenging for private safety-net hospitals because they are located in lower-income communities than the typical hospital.  When Medicaid enrollment falls, these hospitals often find themselves serving more patients without health insurance and providing more uncompensated care.

Learn more in the Families USA report “The Return of Churn: State Paperwork Barriers Caused More Than 1.5 Million Low-Income People to Lose Their Medicaid Coverage in 2018.”

CMS Unveils Medicaid “Scorecard”

The Centers for Medicare & Medicaid Services had introduced a new “Medicaid scorecard” that the agency says it hopes will “…increase public transparency about the programs’ administration and outcomes.”

The scorecard, now posted on the Medicaid web site, presents information and data from the federal government, and reported voluntarily by the states, in three areas:  state health system performance, state administrative accountability, and federal administrative accountability.

The scorecard currently offers information on selected health and program indicators.  Visitors can see comparative data between states and also extensive information about individual state Medicaid programs, including eligibility criteria, enrollment, quality performance, and key state documents such as state plan amendments, waivers, and managed care program overviews.  The site also presents individual state and comparative state performance based on a variety of metrics while also reporting on federal turnaround time on matters such as waiver requests and rate reviews.  CMS envisions the scorecard evolving from year to year by offering more and different information.

Go here to see a CMS fact sheet on the new Medicaid scorecard and go here to visit the scorecard’s home page.

Despite Uncertainty, States Plan to Raise Medicaid Rates

Even though events in Washington leave the future of Medicaid unclear, 44 states still intend to raise at least some of their Medicaid rates in 2018.

Inpatient payments to hospitals are not among the major targets of the planned rate increases:  only 17 states plan to increase Medicaid inpatients payments while the others plan to keep those rates as they are or even reduce them.

Learn more about trends in Medicaid enrollment, spending, and rates in the Kaiser Family Foundation’s annual survey of state Medicaid programs, the results of which can be found here.

Keys to Increasing Medicaid Enrollment

States that have their own health insurance marketplace enroll a higher proportion of Medicaid-eligible residents in their Medicaid programs.

And those that rely on the federal marketplace enroll higher proportions of eligible residents in Medicaid if they let the federal marketplace determine Medicaid eligibility rather than merely refer potentially eligible individuals to their state Medicaid program.

commonwealth fundThese are among the findings in a new Commonwealth Fund report.

The “how” and the “why” are described in greater detail in the report “Streamlining Medicaid Enrollment: The Role of the Health Insurance Marketplaces and the Impact of State Policies,” which can be found here, on the Commonwealth Fund’s web site.