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Medicaid Expansion Briefing: What's at Stake for States?

Friday, November 30, 2012

Following the Supreme Court’s decision this summer on the Patient Protection and Affordable Care Act, the nation’s governors and state leaders face the choice to participate or opt out of the Medicaid expansion. Currently, twelve states have decided to participate in the expansion, seven states have decided to opt out, and the remaining states have yet to announce their participation status. As state officials move forward with selecting an approach, a November 30 briefing examined the economic impact of expanding Medicaid to 138 percent of the federal poverty level.

What will be the financial impact on states that expand their Medicaid programs? What role will the federal government play in financing the expansion? What will the expansion mean for providers on the ground level? If states don’t go forward with the expansion, what will it mean for the safety net population?

A distinguished panel of experts addressed these and related questions.

John Holahan, director of the Health Policy Center at the Urban Institute, and who has decades of experience analyzing Medicaid and state health policy, discussed his updated report on the Medicaid expansion and costs to states.

Krista Drobac, director of the health division at the National Governors Association highlighted the status of states on the expansion and discussed what’s under consideration as states move forward.

James Keeton, vice chancellor for health affairs and dean of the School of Medicine at the University of Mississippi Medical Center, assessed what the expansion would mean at ground level from a provider’s perspective.

Deborah Bachrach, special counsel at Manatt, Phelps & Phillips, and former Medicaid director and deputy commissioner of health for New York, discussed how various states are assessing the fiscal implications of the Medicaid expansion and also described New York’s approach to its expansion options.

Ed Howard of the Alliance and Diane Rowland of Kaiser moderated the discussion.

The event was sponsored by the nonpartisan Alliance for Health Reform and the Kaiser Family Foundation.

Contact: Marilyn Werber Serafini or Beeta Rasouli 202/789-2300


 Ed Howard, The Alliance for Health Reform , Moderator
 Diane Rowland, The Kaiser Family Foundation, Moderator
 John Holahan, Health Policy Center at the Urban Institute, Speaker
 Krista Drobac , National Governors Association, Speaker
 James Keeton , School of Medicine at the University of Mississippi Medical Center, Speaker
 Deborah Bachrach, Manatt, Phelps & Phillips, Speaker
 Q & A, Manatt, Phelps & Phillips, Speaker
(Click on the camera icon to see a video of the speaker's presentation.)

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Medicaid Expansion Briefing: What's at Stake for States? (Adobe Acrobat PDF), 11/30/2012
Full Webcast/Podcast: Medicaid Expansion Briefing Webcast: What's at Stake for States?

The full webcast and podcast for this briefing, as well as videos of individual speakers' presentations, are provided by Kaiser Family Foundation.

Speaker Presentations

Holahan Presentation (Adobe Acrobat PDF), 11/30/2012
Bachrach Presentation (Adobe Acrobat PDF), 11/30/2012
Keeton Presentation (Adobe Acrobat PDF), 11/30/2012
Drobac Presentation (Adobe Acrobat PDF), 11/30/2012

(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)

Source Materials

Agenda (Adobe Acrobat PDF), , 11/30/2012
Materials list (Adobe Acrobat PDF), , 11/30/2012
Selected Experts List (Adobe Acrobat PDF), , 11/30/2012
Speaker Biographies (Adobe Acrobat PDF), , 11/30/2012

Offsite Materials (briefing documents saved on other websites)

Estimates for the Insurance Coverage Provisions of the Affordable Care Act Updated for the Recent Supreme Court Decision (EXCERPT) (Adobe Acrobat PDF),Congressional Budget Office, 7/24/2012
Rise in Medicaid Costs Slows, The Columbus Dispatch, 11/26/2012
Faces of the Medicaid Expansion: Profiles of Uninsured Adults Who Could Gain Coverage, Kaiser Family Foundation, 11/29/2012
Faces of Medicaid Expansion: Experiences of Uninsured Adults Who Could Gain Coverage, Kaiser Family Foundation, 11/29/2012
Issue Brief: State Lawmaker's Guide to Evaluating Medicaid Expansion Projections, The Heritage Foundation, 9/7/2012
The Cost and Coverage Implications of the ACA Medicaid Expansion: State-by-State Analysis (Adobe Acrobat PDF),Kaiser Commission on Medicaid and the Uninsured, 11/26/2012
How Will the Medicaid Expansion for Adults Impact Eligibility and Coverage? (Adobe Acrobat PDF),Kaiser Commission on Medicaid and the Uninsured, 7/1/2012
Implementing the ACA’s Medicaid-Related Health Reform Provisions after the Supreme Court’s Decision (Adobe Acrobat PDF),Kaiser Family Foundation, 11/1/2012
How Rick Scott and Rick Perry Could Cost Hospitals Billions, Forbes, 10/31/2012
The Supreme Court and the Future of Medicaid, The New England Journal of Medicine, 9/13/2012
South Carolina's View: The Affordable Care Act's Medicaid Expansion is the Wrong Approach, Health Affairs Blog, 9/6/2012
Medicaid Expansion: Framing and Planning a Financial Impact Analysis, Robert Wood Johnson Foundation, 9/27/2012
Medicaid Expansion: States' Implementation of the Patient Protection and Affordable Care Act (Adobe Acrobat PDF),Government Accountability Office, 8/1/2012
Expanding Medicaid: The Smart Decision for Maryland, Health Affairs Blog, 8/29/2012
The Supreme Court and Health Reform, Health Affairs Health Policy Brief, 9/27/2012
Medicaid Eligibility Expansion: Arguments For and Against States Opting for ACA Medicaid Expansion, The Piper Report, 9/10/2012
Where Each State Stands on ACA’s Medicaid Expansion: A Roundup of What Each State’s Leadership Has Said about Their Medicaid Plans, The Advisory Board Company, 11/19/2012
How Health Reform's Medicaid Expansion Will Impact State Budgets, Center on Budget and Policy Priorities, 7/25/2012
Mortality and Access to Care among Adults after State Medicaid Expansions, The New England Journal of Medicine, 9/13/2012
Status of the ACA Medicaid Expansion after Supreme Court Ruling (Adobe Acrobat PDF),Center on Budget and Policy Priorities, 11/19/2012
The Ultimate State Medicaid Calculation: RWJF’s Lumpkin on the Implications (3:50), Alliance for Health Reform, 10/12/2012
- The Robert Wood Johnson Foundation’s John Lumpkin points to potential political, financial and human implications of Medicaid expansion in a new Alliance video



John Holahan of the Urban Institute estimated the cost impact on the states of Medicaid expansions at a Nov. 30 briefing, "Medicaid Expansion: What's at Stake for States?" (photo by James Ryder)

States want to know whether they can partially expand, expand over time, or reduce eligibility after expansion, Krista Drobac of the National Governors Association said at a Nov. 30 briefing, Medicaid Expansion: What's at Stake for States? (photo by James Ryder) 

If Mississippi does not expand its Medicaid program, while about 15 percent of the  state remains uninsured, and hospitals lose so-called DSH funds (federal subsidies that help them with the cost of uncompensated care), the University of Mississippi Medical Center "cannot survive in its current form," James Keeton, dean of its school of medicine said at the Alliance's Nov. 30 briefing, "Medicaid Expansion: What's at Stake for States?" (photo by James Ryder) 

States want to know whether they can partially expand, expand over time, or reduce eligibility after expansion, Deborah Bachrach of Manatt, Phelps & Phillips said at a Nov. 30 briefing, Medicaid Expansion: What's at Stake for States? (photo by James Ryder) 


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