Dive Brief:
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Partial Medicaid expansion would give near-poor adults fewer affordable health insurance options with less coverage than full Medicaid expansion, according to a new Center on Budget and Policy Priorities report.
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A handful of states are interested in section 1115 waivers for partial Medicaid expansion. CBPB said CMS should reject those proposals.
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Offering limited Medicaid expansion rather than providing what is allowed under the Affordable Care Act doesn't "further the objectives of Medicaid," the authors of the analysis wrote.
Dive Insight:
Medicaid expansion has been a major part of the ACA's drive to increase the number of insured Americans and has given coverage to more than 14 million people. Despite those gains, Medicaid expansion remains a controversial issue in some states, particularly those with Republican leadership. More than a dozen states haven't expanded Medicaid and those that have are looking for ways to cut costs and members amid tight budgets.
A handful of states, including Kentucky, have received a Medicaid waiver to allow work requirements for eligibility. That state is also charging enrollees who misuse the emergency department. CMS reopened public comment on its work requirement approval, though, after a federal judge invalidated Kentucky's policy.
Arkansas, Massachusetts and Utah eyed possible Medicaid section 1115 waivers that would limit expansion to people making up to 100% of the poverty line, a cut from the 138% allowed by the ACA. So far, Wisconsin is the only state that has gone through with partial expansion. It also doesn't give all Medicaid benefits to those additional members.
CMS rejected Utah's partial expansion plan, and now voters there, as well as those in other states, will decide this fall whether to fully expand Medicaid.
The CBPB report compared how each proposal would affect insured numbers. It found that partial expansion in Utah would add another 70,000 to 90,000 Medicaid members. A full expansion would increase coverage by 150,000.
Other recent studies, including an analysis in Health Affairs, show Medicaid expansion has improved access to and quality of care in states that have implemented it. That report looking at more than 70 studies on the subject found more use of primary care, mental health and preventive visits among Medicaid enrollees in expansion states. Hospital lengths-of-stay among newly insured beneficiaries also decreased.
Plus, Medicaid expansion states have seen improved insurance access for children, more low-income people with a personal physician and more members not delaying care or skipping medications. Another benefit of expansion is reduced uncompensated care for hospitals, advocates argue.