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

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Presentation on theme: "Medicaid Expansion: Critical Decision Point Brian Osberg Center for Best Practices National Governors Association."— Presentation transcript:

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 expansion-decisions 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


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