With many states expanding Medicaid eligibility, individuals leaving jail or prison are now often able to enroll in health coverage upon release. It is increasingly clear, however, that coverage alone is insufficient to...more
On June 7, 2018, Virginia joined 32 other states and the District of Columbia in expanding Medicaid under the Affordable Care Act to adults with incomes at or below 138% of the federal poverty level (FPL). After rejecting...more
To date, 32 states and the District of Columbia have expanded Medicaid under the Affordable Care Act (ACA) to adults with incomes at or below 138% of the federal poverty level (FPL)—newly covering more than 12 million...more
Massachusetts Waiver Amendment Requests Partial Expansion and Closed Formulary -
On September 8, 2017, Massachusetts submitted a waiver amendment request to the Centers for Medicare & Medicaid Services (CMS) to modify its...more
The Senate is poised to vote today, July 25, 2017, on a motion to proceed (MTP) to debate on repealing and possibly replacing the Affordable Care Act (ACA). The MTP allows the Senate to consider the House repeal and replace...more
Next steps regarding Congressional action on repeal and replace remain uncertain, with the President again supporting repeal coupled with replace, members attempting to bridge their differences over the Better Care...more
BCRA Implications: Affordability of Coverage -
In making the case for repealing and replacing the Affordable Care Act (ACA), the president and congressional leadership have cited “rising premiums,” “unaffordable...more
On April 25, 2017, the Maine Department of Health and Human Services released for public comment a draft Section 1115 waiver application to implement new eligibility and coverage requirements for MaineCare, the State’s...more
5/2/2017
/ 1115 Waivers ,
Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Cost-Sharing ,
Department of Health and Human Services (HHS) ,
Eligibility ,
Fee-for-Service ,
Health Insurance ,
Healthcare Reform ,
Medicaid ,
Medicaid Work Requirements ,
Premiums
Editor's Note: Montana's 2016 expansion of Medicaid provides an important opportunity to strengthen the state's substance use disorder (SUD) prevention and treatment system. In a new report for the Montana Healthcare...more
The State of Montana is grappling with a serious and growing public health problem in substance use disorders (SUDs)—including alcoholism, methamphetamine use and opioid abuse and overdose—as well as the related, profound...more
The Future of Essential Health Benefits -
Editor's Note: The Essential Health Benefits (EHB) rule may be among the many parts of the Affordable Care Act (ACA) that are on the chopping block as the Trump Administration and...more
3/24/2017
/ Affordable Care Act ,
Antitrust Immunity ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Essential Health Benefits ,
False Claims Act (FCA) ,
Health Insurance ,
Healthcare Reform ,
Insurer Liability ,
Medicaid ,
Premiums ,
Repeal ,
Trump Administration
Congress is currently debating whether and how to repeal and replace the Affordable Care Act (ACA). This report provides an analysis of the potential impact to the State of Montana of a possible repeal of one portion of the...more
With key leaders in Congress proposing major changes to Medicaid financing through the adoption of a block grant or per capita caps, Manatt has prepared a new toolkit for the Robert Wood Johnson Foundation’s State Health...more
Editor's Note: Since its inception 50 years ago, Medicaid has evolved from a small welfare program into an integral part of the nation's health insurance system, now covering more than one in five low-income children and...more
President-elect Donald Trump and Republican congressional leadership have called for a repeal of the Affordable Care Act (ACA) and a fundamental overhaul of the Medicaid program that would include imposing caps on federal...more
Much of the post-election debate over the potential repeal of the Affordable Care Act (ACA) has focused on the fate of the Marketplaces, the mandate, and popular insurance reforms such as the ban on preexisting conditions....more
Editor’s Note: The United States is in the throes of a rapidly worsening opioid epidemic. The crisis is far-reaching: As of 2014, 1.9 million Americans had an opioid use disorder involving prescription medication, and an...more
Estimated State Budget Impact of an Oklahoma SoonerCare Expansion -
In 2012, the United States Supreme Court ruled that the Medicaid expansion authorized by the Affordable Care Act (ACA) was optional. That is, each...more
Real-Time Data Analytics in Government Investigations and Reducing Exposure -
It is not every day that the words “innovative” and “nimble” are used when referring to an agency of the federal government bureaucracy. Yet,...more
6/24/2016
/ ACOs ,
Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Federal Trade Commission (FTC) ,
Government Investigations ,
Healthcare Fraud ,
HEAT ,
Hospital Mergers ,
IRS ,
MCOs ,
Medi-Cal ,
Medicaid ,
Medicare Advantage ,
OIG ,
Section 340B
Editor's note: Medicaid is the largest healthcare payer in virtually every state. States are increasingly leveraging that position to drive payment and delivery system reform efforts. One powerful tool to enable...more
Overview -
On April 15, 2016, Ohio released a draft Section 1115 waiver application to implement the Healthy Ohio Program. The Healthy Ohio Program, a five-year demonstration beginning in 2018, would modify features of...more
Medicaid continues to gain scale and importance nationally – as both the leading source of health coverage for Americans, and as a change agent within the healthcare marketplace.
With the number of Americans obtaining...more
On December 17, 2015, the Centers for Medicare and Medicaid Services (CMS) approved Michigan’s request to amend its Healthy Michigan Section 1115 demonstration, through which the State provides coverage for more than 594,000...more
Key Findings -
The cost of Medicaid expansion in Kansas is projected to average just over $50 million annually between 2016 and 2020. Based on publicly available data and the experiences of states that expanded in 2014,...more
Editor’s note: Born as an afterthought to Medicare five decades ago, Medicaid has evolved from an adjunct to state welfare programs into the nation’s largest health insurer. Medicaid’s 50th birthday is a fitting time to...more
10/27/2015
/ Affordable Care Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Children's Health Insurance Program (CHIP) ,
Eligibility ,
Enrollment ,
Health Care Providers ,
Health Information Technologies ,
Health Insurance ,
Healthcare ,
Healthcare Costs ,
Healthcare Reform ,
Medicaid ,
Medicaid Expansion ,
Medicaid Reform ,
Public Health Insurance Marketplace ,
State Medicaid Programs ,
Tax Credits ,
Value-Based Purchasing ,
Waivers