5 More things you need to know about Medicaid

5 More things you need to know about Medicaid

Yesterday we talked about the top 5 things you need to know about Medicaid. so we are going to give you another 5.


6. You May Be Surprised by Who the Medicaid Expansion Covers.

The Medicaid expansion will cover working Americans across the demographic spectrum. Many of the newly eligible will be the parents of children who are already on Medicaid or the Children’s Health Insurance Program, and studies have shown that insuring parents also benefits children. The vast majority of the newly eligible are adults who, while working, either do not have access to coverage because their employer does not offer it or cannot afford the health care coverage offered to them. The expansion population will largely comprise younger working adults, older adults whose children have aged out of Medicaid, and people with unmet health care needs who do not yet have access to the Medicare program.

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7. Medicaid Enrollment Increases in Difficult Economic Times.

The Medicaid program grows when the economy struggles, because it provides coverage to Americans who have lost their jobs and access to employer-sponsored insurance. As a counter-cyclical program, it is specifically designed to protect families from the loss of health coverage when unemployment rises or wages shrink and it has done this successfully. Even with increasing enrollment, Medicaid remains an efficient program. Medicaid spends 24% less than employer-sponsored insurance per adult covered. Moreover, administrative costs in Medicaid are only 60% of those in private insurance. In addition, the most recent data show that per-enrollee spending grew at a lower rate than the rest of the healthcare system, as well as slower than the medical consumer price index.

8. Medicaid Enrollees Face Churning Challenges.

“Churning” is an on-and-off-and-on pattern of enrollment that may be unrelated to eligibility status. Fluctuations in income—such as changes in seasonal income, a short-term job, or extra hours at work—cause families to cycle on and off Medicaid coverage. Data show the typical adult enrollee to receive Medicaid coverage for just 8½ months of the year.This disrupts continuity of care and makes preventive medicine more difficult to practice. Extending 12- month continuous eligibility to all Medicaid enrollees would address this issue.

9. Most Medicaid Enrollees are in Managed Care Programs.

Over 70% of Medicaid enrollees are in some form of managed care, and ACAP plans serve almost one-third of those enrolled in capitated managed care programs. Since the mid-1990s, states have been expanding managed care as a means of improving access to quality care and controlling costs in their Medicaid programs. In fact, a study conducted on the effectiveness of capitated managed care programs estimated 10-year savings for the non-duallyeligible population of $83 billion. Managed care provides care management and care coordination, emphasizing prevention and effective utilization of resources. Managed care is also the primary means of quality assessment in the Medicaid program. Plans are measured based on enrollee experience and satisfaction: the results have shown that people in Medicaid managed care are more satisfied with their plans than those with commercial insurance.

10. Medicaid Managed Care is Efficient, High-Quality Care.

Managed care plans coordinate the care and needs of their members in a way that reduces waste, improves efficiency, contains cost, and maintains and improves the quality of care. In 2010, more than three-quarters of national Medicaid spending was not capitated, including most of the care for the costliest groups of individuals, such as the approximately 9 million individuals who have both Medicare and Medicaid coverage. These “dual eligibles” are more likely to live with multiple chronic conditions and need care coordination to maintain their health and independence. Recognizing that expansions of managed care hold great promise for generating significant cost savings, states and the federal government are working together to develop and implement such programs.

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