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Health and Health Coverage in the South: A Data Update

February 1, 2016

With its recent adoption of the Affordable Care Act (ACA) Medicaid expansion to adults, Louisiana became the 32nd state to move forward with the expansion, and the 7th of the 17 states that make up the American South to expand. However, within the South, which has high rates of chronic disease and poor health outcomes, the majority of states still have not adopted the Medicaid expansion. The ACA and its Medicaid expansion offer important opportunities to expand access to health coverage, particularly in the South, where Medicaid and CHIP eligibility levels across groups have lagged behind other regions for many years.1 While many factors contribute to chronic disease and poor health outcomes, expanding health coverage can provide an important step in improving health by supporting individuals' ability to access preventive and primary care and ongoing treatment of health conditions. This brief provides key data on the South and the current status of health and health coverage in the South to provide greater insight into the health needs in the region and the potential coverage gains that may be achieved through the ACA. State specific data for the indicators presented in the brief are available in Tables 1 through 6.

Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies as of January 2016: Findings from a 50-State Survey

January 19, 2016

January 2016 marks the end of the second full year of implementation of the Affordable Care Act's (ACA) key coverage provisions. This 14th annual 50-state survey of Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies provides a point-in-time snapshot of policies as of January 2016 and identifies changes in policies that occurred during 2015. Coverage is driven by two key elements -- eligibility levels determine who may qualify for coverage, and enrollment and renewal processes influence the extent to which eligible individuals are enrolled and remain enrolled over time. This report provides a detailed overview of current state policies in these areas, which have undergone significant change as a result of the ACA.Together, the findings show that, during 2015, states continued to implement the major technological upgrades and streamlined enrollment and renewal processes triggered by the ACA. These changes are helping to connect eligible individuals to Medicaid coverage more quickly and easily and to keep eligible people enrolled as well as contributing to increased administrative efficiencies. However, implementation varies across states, and lingering challenges remain. The findings illustrate that the program continues to be a central source of coverage for low-income children and pregnant women nationwide and show the growth in Medicaid's role for low-income adults through the ACA Medicaid expansion.

Characteristics of Poor Uninsured Adults who Fall into the Coverage Gap

December 13, 2013

One of the major coverage provisions of the 2010 Affordable Care Act (ACA) is the expansion of Medicaid eligibility to nearly all low-income individuals with incomes at or below 138 percent of poverty (about $16,000 for an individual) This expansion fills in historical gaps in Medicaid eligibility for adults and was envisioned as the vehicle for extending insurance coverage to low-income individuals, with premium tax credits for Marketplace coverage serving as the vehicle for covering people with moderate incomes. While the Medicaid expansion was intended to be national, the June 2012 Supreme Court ruling made it optional for states, and as of December 2013, 25 states are not expanding their programs. Medicaid eligibility for adults in states not expanding their programs is quite limited -- the median income limit for parents in 2014 will be 47% of poverty, or an annual income of about $9,200 a year for a family of three, and in nearly all states not expanding, childless adults will remain ineligible. Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults will fall into a "coverage gap" of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits. Nationwide, nearly five million poor uninsured adults are in this situation. This brief describes the population in the coverage gap and discusses the implications of them being left out of ACA coverage expansions.

Emerging Medicaid Accountable Care Organizations: The Role of Managed Care

May 29, 2012

Examines the Medicaid payment and care delivery systems in states working to develop accountable care organizations within Medicaid, how ACOs may be structured to fit into them, and how Medicaid ACOs differ from those in Medicare and the private market.

How Is the Affordable Care Act Leading to Changes in Medicaid Today? State Adoption of Five New Options

May 18, 2012

Examines state takeup of five Medicaid options under federal healthcare reform, including early expansion of coverage, funding to upgrade eligibility systems and disease prevention, health homes for the chronically ill, and integration of dual eligibles.

Enrollment-Driven Expenditure Growth: Medicaid Spending During the Economic Downturn, FFY2007-2010

May 4, 2012

Examines Medicaid spending growth by category and per enrollee, and the role of and factors behind enrollment growth, including the recession, federal protections against eligibility restrictions, additional funding, and expanded eligibility.

The Diversity of Dual Eligible Beneficiaries: An Examination of Services and Spending for People Eligible for Both Medicaid and Medicare

April 18, 2012

Analyzes updated data on the characteristics, health status, healthcare utilization, and spending for those eligible for both Medicaid and Medicare compared with those of non-dual eligible Medicare beneficiaries and implications of their diversity.

Massachusetts' Proposed Demonstration to Integrate Care for Dual Eligibles

April 18, 2012

Outlines the current service delivery model for those eligible for both Medicaid and Medicare, key design elements of the proposed integrated care organizations, revisions made in response to stakeholder comments, and considerations for evaluation.

Governors' Budgets for FY 2013 - What Is Proposed for Medicaid?

March 27, 2012

Examines trends in governors' Medicaid budget proposals, including expected shortfalls, fiscal priorities, additional spending cuts, policy actions to control Medicaid costs, and targeted investments, as well as tax cuts and fiscal reform proposals.

Medicaid and Community Health Centers: The Relationship Between Coverage for Adults and Primary Care Capacity in Medically Underserved Communities

March 23, 2012

Compares the strength of health centers in states with expanded Medicaid coverage for adults and those in states with limited Medicaid coverage for adults, in terms of number of sites, patients, and staff; revenue; and proportion of revenue from Medicaid.

Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012

January 18, 2012

Analyzes findings on state trends in maintaining or expanding eligibility for public coverage and improving enrollment and renewal procedures. Highlights some states' expansion of Medicaid eligibility and the use of technology to achieve efficiencies.

Changes in Health Insurance Coverage in the Great Recession, 2007-2010

December 15, 2011

Examines trends in the number of uninsured by age, race/ethnicity, work status, citizenship status, and region; contributing factors such as the decline in employer-sponsored coverage and real incomes; and mitigating factors such as Medicaid provisions.