Medicaid Expansion: Critical Decision Point

1. Medicaid Expansion:Critical Decision Point Brian Osberg Center for Best Practices National Governors Association

2. About NGA • Federal Relations/Advocacy • Center for Best Practices; Non-Profit

3. Medicaid Expansion:State Option • Part of Federal Health Reform Law • Near “universal coverage” • Surprising Supreme Court Decision • Economic, Financial and Political Factors

4. Covered Population • Adults under 65 with income under 138% of Federal Poverty Level (FPL) • Approximately half of the uninsured • Mostly adults without dependent children • Partial Expansion Not Permitted

5. Covered Population • Potential Growth of 21.3 Million by 2022 • Continued Restrictions for Non-Citizens • Streamlined Eligibility Determination • Coordinated with Insurance Exchange • Increased Outreach and Application Assistance • Spectrum of Coverage

6. What is Covered? • Must cover 10 “essential health benefits” • Includes Mental Health and Substance Abuse • Known as “Alternative Benefit Plans” • Exemptions for “Medically Frail” Continue • Limited Cost Sharing; No Premiums

7. Medicaid Management • Trend Towards Managed Care Continues • New Models of Delivery/Payment • Health Homes; Behavioral Health Homes • Medicaid Accountable Care Organizations • Bundled Payment • Intensive Care Management for ‘Super-Utilizers’ • Integration of Mental and Physical Health

8. Health Management Challenges • Unmet Medical Needs • Multiple Social Service Issues • Multiple Chronic Conditions • Requires Innovative Approach • Camden Model • Hennepin Health

9. Expansion Status • http://www.statereforum.org/medicaid-expansion-decisions • Let’s Make A Deal • Decision Can Be Reversed • Too Early to Tell

10. Thank You • Brian Osberg, Acting Director, Health Division Center for Best Practices National Governors Association bosberg@nga.org