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 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