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Medicaid Expansion: Critical Decision Point

Medicaid Expansion: Critical Decision Point. Brian Osberg Center for Best Practices National Governors Association. About NGA. Federal Relations/Advocacy Center for Best Practices; Non-Profit. Medicaid Expansion: State Option. Part of Federal Health Reform Law Near “universal coverage”

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Medicaid Expansion: Critical Decision Point

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  1. Medicaid Expansion:Critical Decision Point Brian Osberg Center for Best Practices National Governors Association

  2. About NGA • Federal Relations/Advocacy • Center for Best Practices; Non-Profit

  3. Medicaid Expansion:State Option • Part of Federal Health Reform Law • Near “universal coverage” • Surprising Supreme Court Decision • Economic, Financial and Political Factors

  4. Covered Population • Adults under 65 with income under 138% of Federal Poverty Level (FPL) • Approximately half of the uninsured • Mostly adults without dependent children • Partial Expansion Not Permitted

  5. Covered Population • Potential Growth of 21.3 Million by 2022 • Continued Restrictions for Non-Citizens • Streamlined Eligibility Determination • Coordinated with Insurance Exchange • Increased Outreach and Application Assistance • Spectrum of Coverage

  6. What is Covered? • Must cover 10 “essential health benefits” • Includes Mental Health and Substance Abuse • Known as “Alternative Benefit Plans” • Exemptions for “Medically Frail” Continue • Limited Cost Sharing; No Premiums

  7. Medicaid Management • Trend Towards Managed Care Continues • New Models of Delivery/Payment • Health Homes; Behavioral Health Homes • Medicaid Accountable Care Organizations • Bundled Payment • Intensive Care Management for ‘Super-Utilizers’ • Integration of Mental and Physical Health

  8. Health Management Challenges • Unmet Medical Needs • Multiple Social Service Issues • Multiple Chronic Conditions • Requires Innovative Approach • Camden Model • Hennepin Health

  9. Expansion Status • http://www.statereforum.org/medicaid-expansion-decisions • Let’s Make A Deal • Decision Can Be Reversed • Too Early to Tell

  10. Thank You • Brian Osberg, Acting Director, Health Division Center for Best Practices National Governors Association bosberg@nga.org

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