Scenario
You are the director of community affairs for the health lobby organization, Pathways to a Healthy America. In 2010, President Barack Obama signed the Affordable Care Act into law. As a result, millions of Americans who were previously uninsured gained access to the healthcare system. One of the initial provisions of the Act required individual states to expand the eligibility criteria for Medicaid. The program’s costs would be absorbed by the federal government at a rate of 100% for the first three years of program participation which would decrease to 90% after 2020, still, considerably higher than previous funding by the federal government. However, in 2012, the Supreme Court ruled the mandate unconstitutional allowing individual states to voluntarily “opt” out of the Medicaid expansion program. As a result of the various states’ decision to “opt” out of the ACA’s Medicaid expansion, millions of adults fell into the critical coverage gap. Your organization represents a state which has decided to forego participation in the ACA expansion program. The decision was met with both praise and criticism.
It has now been a few years since the decision and your organization has gathered information on the impact of the decision in order to advocate for Medicaid reform during the next state legislative session.
You are required to write an advocacy report to state lawmakers in which you advocate for either participating in the original expansion program or participating with conditions (waivers) to address the critical gap in coverage for vulnerable adults in your state. Waivers such as Section 1115 enable for alternative implementation of Medicaid expansion and allow states to impose restrictions which may result in a denial of Medicaid eligibility for individuals who do not meet those restrictions, i.e., work requirements.
Research the Medicaid expansion program offered through the Affordable Care Act (ACA) as well as Medicaid reform initiatives using waivers to increase access to Medicaid. Determine, based on your state’s profile, which process (the ACA’s expansion program or the use of waivers) is most beneficial to your state. Include a comprehensive, well-supported recommendation for participation in Medicaid reform using either the ACA’s program or a modified reform process using waivers.
Your advocacy report should describe your state’s current Medicaid program including its eligibility criteria, demographics, Medicaid spending and savings since the ACA’s implementation, and comprehensive details of current or pending waivers. You should also include a discussion (benchmark) on another state’s success with Medicaid reform using your recommended strategy (the ACA’s expansion program or the use of the specific types of waivers for which you propose).
Full Answer Section
Current Medicaid Landscape in [Your State]
Eligibility Criteria: Briefly describe your state's current Medicaid eligibility criteria, including income thresholds and coverage categories (e.g., pregnant women, children, disabled adults). Highlight any recent changes or limitations.
Demographics: Provide a brief overview of the demographics of your state's Medicaid population, including age, race, and location (rural vs. urban).
Medicaid Spending and Savings: Analyze any available data on Medicaid spending trends in your state since the ACA's implementation (2010). If applicable, discuss any reported cost savings associated with the ACA, such as a decrease in uncompensated care costs borne by hospitals.
Waivers: Research and detail any current or pending Medicaid waivers in your state. Specify the waiver type (e.g., Section 1115 demonstration waiver) and its intended purpose (e.g., implementing work requirements). Evaluate the effectiveness of these waivers in expanding coverage or achieving their stated goals.
Recommendation: ACA Expansion vs. Waiver-Based Reform
Considering your state's specific circumstances (demographics, budget, existing waivers), analyze the advantages and disadvantages of participating in the ACA's Medicaid expansion program compared to pursuing reform through waivers.
- ACA Expansion:
- Advantages:
- Full federal funding for the first three years, then 90% thereafter, significantly reducing the state's financial burden.
- Covers a broader range of low-income adults, potentially reducing the number of uninsured residents and uncompensated care costs.
- Improves access to preventive care, leading to better overall health outcomes and potentially lower long-term healthcare costs.
- Disadvantages:
- Potential for future federal funding reductions or changes in eligibility requirements.
- Concerns about program sustainability in the long term.
- Waiver-Based Reform:
- Advantages:
- States have more flexibility in program design (e.g., imposing work requirements).
- May offer a path to coverage expansion while addressing concerns about program costs.
- Disadvantages:
- Limited federal funding compared to the ACA expansion.
- Waivers often come with complex requirements and restrictions, potentially creating administrative burdens.
- Work requirements and other restrictions might discourage eligible individuals from enrolling, limiting the program's effectiveness.
Benchmark State:
Select another state that has successfully implemented your recommended approach to Medicaid reform (ACA expansion or specific waiver program). Provide details on their program's design, key metrics (e.g., enrollment numbers, cost savings), and positive impacts on the state's healthcare system.
Focus on a state with similar demographics or economic profile to strengthen the argument for its applicability to your own state.
Conclusion
Pathways to a Healthy America urges the state legislature to prioritize expanding health insurance coverage for low-income adults in [Your State]. We believe that participating in [recommend either ACA expansion or specific waiver program with justification] is the most effective way to achieve this goal. By following the successful model of [benchmark state], we can improve health outcomes for our most vulnerable residents, stimulate the economy through a healthier workforce, and reduce the overall burden of uncompensated care.
Data Sources:
- Use credible sources like Medicaid.gov, Kaiser Family Foundation (KFF), Center on Budget and Policy Priorities (CBPP), and state government websites to support your claims with data and statistics.
Call to Action
Conclude with a clear call to action, urging lawmakers to consider your recommendations and support legislation that expands Medicaid access for vulnerable adults in your state.
By following this outline and conducting thorough research on your state's specific situation and successful models in other states, you can create a compelling advocacy report that promotes Medicaid reform and improves healthcare access for your most vulnerable residents.