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Medicaid 101: What You Need to Know

Friday, March 20, 2015

With some states grappling over whether to expand Medicaid, and Congress facing big decisions about the future of the Children’s Health Insurance Program (CHIP), this briefing reviewed the basics about both programs and discuss current issues.

Medicaid is a federal-state partnership that provides health coverage to low-income individuals, including families, people with disabilities, and seniors. Since the enactment of the Affordable Care Act (ACA), more adults can now qualify for Medicaid coverage in states that have expanded the program. According to the Centers for Medicare and Medicaid Services (CMS), approximately 69 million adults and children were enrolled in Medicaid and CHIP as of November 2014.

What is Medicaid, and why was it created? What benefits does the program cover? What do we know about enrollment and expenditures in Medicaid? How is the program financed and administered? What changes did the ACA make to Medicaid? What are the trends in delivery system and payment reform across states, and what are their policy implications? What are the key issues facing Medicaid? With CHIP funding set to expire on September 30, 2015, what does the future hold for children’s health coverage?

If you were unable to attend the briefing, here are some key takeaways:

Robin Rudowitz, associate director, Kaiser Commission on Medicaid and the Uninsured
Robin Rudowitz stated that Medicaid covers 1 in 5 Americans. She also noted that spending for the elderly and disabled patients accounts for two-thirds of Medicaid spending. Twenty-nine states including DC have adopted the Medicaid expansion, she added.

Thomas Betlach, president of the board, National Association of Medicaid Directors, and director
According to a NAMD survey, 77% of Medicaid directors identified their top four priorities as: payment and delivery reform, implementation of the Affordable Care Act, Long-Term Services and Supports and duals, and eligibility and enrollment systems. Turnover among Medicaid directors and maintaining staff poses a challenge for moving the program forward, he stated.

Anne Schwartz, executive director, Medicaid and CHIP Payment and Access Commission (MACPAC)
Anne Schwartz highlighted that the number of uninsured children has dropped by half since the enactment of the Children's Health Insurance Program (CHIP). While reauthorization for the program is not needed, extended CHIP funding for the program is set to expire on September 30, 2015. She added that 3.7 million children would need a new source of coverage if CHIP funding is not renewed.

Vikki Wachino, acting director, Center for Medicaid and CHIP Services, CMS
Since open enrollment period began in October 2013, 11 million people have enrolled in Medicaid and CHIP, serving as a testament to CMS's success in making the enrollment process simpler and more consumer friendly, Vikki Wachino said. But, benefits extend past just enrollment numbers. In Kentucky, for example, 15,000 jobs have been created as a result of Medicaid expansion, she added.

Ed Howard of the Alliance and Barbara Lyons of Kaiser moderated.

Follow the briefing on Twitter: #Medicaid101

Contact: Beeta Rasouli (202)789-2300

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


 Robin Rudowitz, Kaiser Commission on Medicaid and the Uninsured, Speaker
 Thomas Betlach, National Association of Medicaid Directors, Speaker
 Anne Schwartz, Medicaid and CHIP Payment and Access Commission (MACPAC), Speaker
 Vikki Wachino, Center for Medicaid and CHIP Services, CMS, Speaker
(Click on the camera icon to see a video of the speaker's presentation.)

Transcript, Event Summary and/or Webcast and Podcast

Transcript: Transcript (Adobe Acrobat PDF), 3/20/2015
Full Webcast/Podcast: Full Video from Kaiser Family Foundation

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

Speaker Presentations

Robin Rudowitz Presentation (Adobe Acrobat PDF), 3/20/2015
Thomas Betlach Presentation (Adobe Acrobat PDF), 3/20/2015
Anne Schwartz Presentation (Adobe Acrobat PDF), 3/20/2015

(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), , 3/20/2015
Speaker Biographies (Adobe Acrobat PDF), , 3/20/2015
Source List (Adobe Acrobat PDF), , 3/20/2015
Materials List (Adobe Acrobat PDF), , 3/20/2015

Offsite Materials (briefing documents saved on other websites)

The Academy Health Listening Project: Improving the Evidence Base for Medicaid Policymaking (Adobe Acrobat PDF),Academy Health, 2/1/2015
Covering Health Issues: A Sourcebook for Journalists Fall 2013, Chapter 9 – Medicaid and CHIP, The Alliance for Health Reform, 3/19/2015
Medicaid Innovation: Delivery System Reform Incentive Pools (Adobe Acrobat PDF),National Association of Medicaid Directors, 6/1/2014
Medicaid Moving Forward, The Henry J. Kaiser Family Foundation, 3/9/2015
Medicaid Pay Bump Helps Beneficiaries Get Appointments, Modern Healthcare, 1/21/2015
State Children’s Health Insurance Program (CHIP) (Adobe Acrobat PDF),Medicaid and CHIP Payment and Access Commission, 3/1/2015
A Look at CBO Projections for Medicaid and CHIP, The Henry J. Kaiser Family Foundation, 6/5/2014
An Overview of Delivery System Reform (DSRIP) Waivers, The Henry J. Kaiser Family Foundation, 9/29/2014
Appointment Availability after Increases in Medicaid Payments for Primary Care, The New England Journal of Medicine, 2/5/2015
The ACA and Recent Section 1115 Medicaid Demonstration Waivers (Adobe Acrobat PDF),The Henry J. Kaiser Family Foundation, 2/1/2014
Benefits and Cost Sharing in Separate CHIP Programs: Policy Implications in the Context of the ACA (Adobe Acrobat PDF),Georgetown University Health Policy Institute, Center for Children and Families & National Academy for State Health Policy, 5/7/2014
Children’s Health Insurance Program (CHIP): Accomplishments, Challenges, and Policy Recommendations, Committee on Child Health Financing, 1/27/2014
The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update, The Henry J. Kaiser Family Foundation, 11/12/2014
Fact Sheets: Medicaid Innovation Accelerator Program Fact Sheet, Centers for Medicare & Medicaid Services, 7/14/2014
“Getting MAGI Right: A Primer on Differences that Apply to Medicaid and CHIP (Adobe Acrobat PDF),Georgetown University Health Policy Institute, Center for Children and Families, 1/1/2015
March 2015 Report to Congress on Medicaid and CHIP, Medicaid and CHIP Payment and Access Commission, 3/1/2015
Medicaid & CHIP: November 2014 Monthly Applications, Eligibility Determinations and Enrollment Report (Adobe Acrobat PDF),Centers for Medicare & Medicaid Services, 2/2/2015
Poor Americans Deserve a More Compassionate Health Care Solution than Current Medicaid, The Daily Signal, 11/19/2014
Revisions to CBO’s Projections of Federal Health Care Spending, Congressional Budget Office, 7/28/2014
State Demonstration Proposals to Integrate Care and Align Financing and/or Administration for Dual Eligible Beneficiaries, The Henry J. Kaiser Family Foundation, 2/6/2015
State Innovation Models Initiative: General Information, Centers for Medicare & Medicaid Services, 3/1/2015
Subcommittee on Health Hearing entitled ‘The Future of the Children’s Health Insurance Program (Adobe Acrobat PDF),113th Congress of the United States, House of Representatives, Committee on Energy and Finance, Subcommittee on Health, 12/1/2014
Updated Budget Projections (Adobe Acrobat PDF),Congressional Budget Office, 3/1/2015
Where the States Stand on Medicaid Expansion, The Advisory Board Company, 2/11/2015
Fiscal Year 2016 Budget: A Balanced Budget for a Stronger America (Adobe Acrobat PDF),House Budget Committee, 3/1/2015
A Balanced Budget That Supports Economic Growth And Expands Opportunity for Hardworking Families, Senate Budget Committee, 3/18/2015


In Kentucky, 15,000 jobs have been created as a result of Medicaid expansion, Vikki Wachino, acting director, Center for Medicaid and CHIP Services, CMS, stated at a March 20 Alliance briefing, Medicaid 101: What You Need to Know.


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