Medicaid Expansion and the Future of the Program

This year represents the 50th anniversary since the creation of Medicaid and during the past 5 decades, the program has evolved into the nation’s largest health insurer and it is set to evolve yet again as the Affordable Care Act (ACA) has given Medicaid an even larger role in the nation’s healthcare, according to a Viewpoint published in the Journal of American Medical Association.

Since the first open enrollment period under the ACA, enrollment in Medicaid has increased 21% from 58.8 million people covered to 71.1 million, CMS reported in May 2015, and the program is projected to account for $343 billion in total spending in 2015, according to the Congressional Budget Office.

However, with 21 states that have yet to expand Medicaid there are still approximately 4.3 million adults who could be covered by Medicaid in these states, but who remain uninsured, according to the publication.

“The case for expansion is very strong, and the pragmatism that typically characterizes state government would suggest that states will close the gap over the next few years,” authors Cindy Mann, HD, and Elizabeth Osius, MPA, wrote.

They expect waivers to play a key role in the future of Medicaid expansion. Although most states expanded the program without a waiver, they provide states with the opportunity to put their “unique stamp” on expansion of Medicaid just as Arkansas and Iowa did.

As the Medicaid program moves forward, more attention will need to be paid to the 22% of enrollees who account for more than half of the program’s expenditures, Mann and Osius point out. These high-need individuals provide opportunity to reform payment and delivery to improve care and avoid preventable and inefficient costs.

“Medicaid has regularly been reinvented to meet the needs of a new time, a new population, or a new health care crisis,” Mann and Osius concluded. “Reinvention is underway yet again, and if past is prologue, the path will not be easy, but the program will continue to move forward.”