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Medicaid enrollment, cost, outlook for expansion, work requirements

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Donald Trump Seema Verma
President
Donald Trump listens to Seema Verma, administrator of the Centers
for Medicare and Medicaid Services

Mark Wilson/Getty Images

  • For the first time in a decade, Medicaid enrollment did not
    grow in 2018.
  • According to a new Kaiser Family Foundation report,
    enrollment fell 0.6% in 2018.
  • Medicaid spending continued to rise, increasing 4.2% in 2018,
    due to a higher number of seniors enrolling.
  • The drop in enrollment was due to the strong economy and
    policy changes made by states.
  • Medicaid enrollment could change significantly in the next
    few years given policy changes such as work requirements and ACA
    expansion being considered by state governments.

For the first time in a decade, Medicaid enrollment hasn’t grown
in 2018.

While enrollment into Medicaid, the state and federal
program that covers medical care for some low-income
Americans, slowed down in 2018, spending continued grew 4.2%
compared to 2017, according to a survey conducted by the Kaiser
Family Foundation.

KFF attributed the growth in spending to the number of seniors
joining the program compared to children and adults, who are less
expensive to cover. States told KFF that a stronger economy led
to fewer adults qualifying for the program.

Medicaid is designed to help low-income Americans get
access to healthcare, though the exact threshold for
qualification depends on whether the state expanded Medicaid
eligibility under the Affordable Care Act (ACA), also known as
Obamacare. In states that expanded Medicaid eligibility, adults
who make as much as 138 percent of the poverty level can qualify.
In those that didn’t, the thresholds are far lower, and the
program can mainly serve some disabled individuals and parents
and their children.

With unemployment hitting multi-decade lows and wages
rising, the number of Americans climbing above those cut-offs
more than offset the general population growth and other changes
in the composition of Medicaid enrollees. Medicaid enrollment
last declined in 2007, according to the survey.

The organization also attributed the growth in spending in
part to more outlays for pricey medications like treatments for
HIV and hepatitis C, as well as more getting spent on
substance-use treatment, mental health, and long-term care for
seniors and those with disabilities, as well as policy changes
that raised the amount of money doctors and nurses are getting
paid.


medicaid spending enrollment 1998 2019Samantha Lee/Business Insider

While the Medicaid enrollment rate remained steady in 2018
and is expected to do so again next year, the authors of Kaiser’s
study did point to a few political factors that could affect the
outlook.

“Looking ahead, economic conditions and the outcome of
federal and state elections are likely to have implications for
Medicaid policymaking as well as for spending and enrollment
trends,” the report reads. “Potential federal efforts to further
change the ACA or cap Medicaid financing as well as state ballot
initiatives and other
state efforts to adopt the Medicaid expansion are key issues to
watch.”

Currently, three states will vote on Medicaid expansion in
the 2018 midterms — Idaho, Utah, and Nebraska — which could help
boost enrollment numbers as previously ineligible people in those
states could be able to get access to Medicaid. According to
estimates, just under 120,000 people could be eligible for
Medicaid if Idaho votes
for expansion
, 86,000 could be eligible in
Nebraska
, and 158,000 could be eligible in Utah.

But working in the other direction is a slew of new
proposals from states that would change eligibility rules for
Medicaid, the most notable being the
imposition of work requirements
. The Trump administration has
allowed states to set rules to impose a minimum amount of hours
that a Medicaid enrollee must work, or do other activities like
volunteering or training.

While most enrollees are either disabled, too old to
qualify, or already work, administrative difficulties and other
factors are expected to result in enrollment declines for states
that do impose work requirements. Arkansas, which imposed a work
requirement in June, has already seen
enrollment drop by just under 8,500
in just two
months.

Indiana and New Hampshire already have waivers approved by
the Trump administration to start the requirements in 2019, while
four others states — Alabama, Maine, Ohio, and South Dakota —have
waivers pending. One state, Kentucky,
must resubmit a waiver
due to a court order before rolling
out its work requirement.

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