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Medicaid and the Affordable Care Act – What’s the Hubbub About?

Stacey Bickford | Jun 7, 2013

With many unknowns in the industry around the Affordable Care Act (ACA), State Medicaid changes are well on their way!  The question is what changes are taking place in your state?  With Federal funding increases and expansion in Medicaid coverage as of January 1, 2014, the Federal Government gave the decision to the State on whether to participate.  Although many states have shown interest in federally funded Medicaid expansion, and have participated in early adoption and discussions, some are unsure of participation based on funding and staffing concerns. 

What does the ACA mean for Medicaid expansion?  Medicaid expansion will open up benefits to non-covered Adults who meet 138% of the Federal Poverty Level (FPL).  It is expected that over 9 million current self-pay patients will have healthcare coverage through federally funded health insurance exchanges in 2014 and 25 million by 2022.  The Federal Government will handle 100% funding, for newly covered beneficiaries based on these changes, in participating states.  This percentage will decrease gradually, over the years, eventually declining to 90% by 2020.

What is a Health Insurance Exchange as it pertains to Medicaid?  It is a centralized location where individuals and small employers can compare and purchase health insurance options served through a private insurance company.  These Health Exchange plans must be certified as Qualified Health Plan (QHP) and must offer a minim set of benefits called Essential Health Benefits (EHB).  The state can decide to participate in a federally-facilitated exchange or a state-facilitated exchange.  It is anticipated that two thirds of new enrollees will be through a health exchange. 

As of April 25, 2013, 26 states indicated that they will participate in the Medicaid expansion related to the ACA.  The scope of participation will be determined on what type of exchange the state determined is best suited for their needs.  Some of the 26 states (and DC) participating include Arizona, California, Florida, Massachusetts, Michigan, New Jersey, Ohio and Tennessee.  On the flip side, 11 states have indicated that they will not be participating in Medicaid expansion.  These states have selected non-participation for reasons such as lack of funding to implement necessary changes, burden greater than the benefit or even political stances on the ACA.  States that have decided not to participate in Medicaid Expansion are Alabama, Georgia, Idaho, Iowa, Louisiana, Mississippi, North Carolina, South Carolina, South Dakota, Texas and Wisconsin. 

Okay, so what do all of these statistics mean for transportation? Part of the minimum benefits required for Health Exchanges include Transportation to Medical Care.  In my opinion a reduction in self-pay patients can only benefit reimbursement in the long run. As we all know, self-pay patients do not guarantee payment, and although Medicaid reimbursement is nowhere near as lucrative as private insurance, some is better than none!

What can you do?! Get involved! Right now is the time to participate in your state’s decision, find out who your State Representative is and share your opinions! If your state was not listed above as a participating or non-participating state, get involved to find out what you state is working on.  The only way to influence change is to act, and now is the time!

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