Medicaid Trends

There are a number of important trends in Medicaid that are shaping which services are authorized, how services are funded, funding amounts, and access to care.

  1. Medicaid is currently the largest source of federal funds flowing to the states, with $500 billion spent on services to approximately 65 million people in 2014.
  2. The emphasis in today’s environment is to manage care through a combination of strategies.
  3. Between 2011 and 2014, most states have enacted policies to reduce Medicaid expenditures. Primary strategies have included cost containment through reducing reimbursement rates, requiring co-pays from enrollees, and imposing additional restrictions on care and access to services.
  4. In some states, providers are incentivized to manage patients with chronic conditions, and both Medicare and Medicaid are experimenting with strategies that help patients with chronic conditions more effectively manage their health and reduce the use of institutional resources like hospitals, hospital emergency departments, and nursing homes.
  5. Many states are developing or expanding their Home and Community Based Services (HCBS) because they have demonstrated that a mix of services provided in home and community settings are more effective in managing chronic health conditions and are much more cost effective than more intensive levels of care, like nursing homes.
  6. Medicaid and Medicare are emphasizing more integrated systems of care, including hospitals and nursing homes, community providers, home based services, and case management.
  7. The Federal Centers for Medicare and Medicaid (CMS) are working with states and provider groups to address problems such as high hospital readmission rates, high costs for treating patients with chronic health conditions, and costs for caring for the frail elderly.  CMS is funding a range of pilot projects that successfully address these issues.
Anne Hays Egan
New Ventures Consulting
Medicaid Trends

For more information, check: Kaiser Family Foundation; National Association of States United for Aging and Disabilities; and LifeHealth Pro