Update on Medicaid

Medicaid Expansion

If you’ve been affected by our nation’s two major recessions, you likely qualify for Medicaid. And you are not alone – in the past 15 years, enrollment in Medicaid has surged. In 2014, you and countless other voters helped influence state decisions on the newest Medicaid expansion. But will you be covered?

With this expansion, your state will provide more long-term service and support (LTSS) dollars to loved ones and people within your communities in need. Currently there are 28 states that have adopted Medicaid Expansion. Seven are still discussing the expansion decisions, and 20 have decided not to enroll in Medicaid Expansion.

If expansion is approved in your state, the government will cover 100 percent of the Medicaid costs up to three calendar years for those newly eligible for Medicaid. In certain states, your accessibility to dental coverage, mental health care and substance misuse services could be in jeopardy. Many states plan to increase spending toward managed care organizations and nursing homes in order to expand the care they provide to a growing population of children, adults and seniors.

If you’re covered within the new Medicaid expansion you’ll receive “Alternative Benefit Plans” (ABPs) –a term synonymous with Medicaid benchmark benefits. The benefits you receive are determined by the collective needs of people in your demographic region. In comparison to traditional Medicaid benchmark benefits, ABPs will stay aligned with the traditional benefit package. The ABPs will include:

  • physical and mental health/substance use disorder benefits
  • all of the essential health benefits
  • family planning services and supplies
  • non-emergency medical transportation
  • federally qualified health center and rural health clinic services

Medicaid premiums have been revised as well. This means you could face maximum copayment amounts of $4 for outpatient services and $75 per inpatient admission. You could accrue up to an $8 charge for non-preferred drugs and non-critical use of emergency departments. If you’re above the 150% FPL level, you might experience higher charges, but the rates are locked in if you fall below that FPL level.

2015 At A Glance

  • The Medicaid expansion will allow easier access to healthcare and will simplify eligibility and enrollment
    • The expansion will help fund new health centers for over 21 million beneficiaries
  • Home and community-based services have doubled nearly 20% since 1995.
  • Within the previous year, Medicaid fees rose 73% on average to analogous Medicare fees

Medicaid reforms look to become more encompassing than ever. With slow economic recovery, it is important that people with complex health and long-term care needs are being taken care of. States choosing to not expand Medicaid will temporarily forgo increased coverage available to low-income residents. Those who do get the Medicaid expansion will not only get more coverage but also potential savings.

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