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Report: Record Medicaid Growth, Reforms

Medicaid expansion under the Affordable Care Act in 29 states, including California, has driven record enrollment and spending for the program in fiscal year 2015, according to a report by the Kaiser Family Foundation.

In California, about 12 million people are enrolled in the Medicaid program, called Medi-Cal.

In states that expanded Medicaid, enrollment and spending grew nearly three times that of non-expansion states. Medicaid spending rose 17.7% in expansion states, compared to 6.1% in non-expansion states. Enrollment rose by 18% overall in expansion states, compared to 5.1% in non-expansion states, according to the report that surveyed Medicaid directors in 50 states.

Because the federal government has picked up all costs of covering newly eligible enrollees, states that expanded Medicaid saw more modest spending growth (3.4%) compared to non-expansion states (6.9%), the report authors found.

“States that opted to expand Medicaid saw significant gains in coverage, reductions in the uninsured, and access to additional federal funds,” said Diane Rowland, executive vice president of the Kaiser Family Foundation. “But many other changes are underway in Medicaid programs across the country as states engage in an array of delivery system reforms to help coordinate care and control costs.”

Managed care is now the predominant delivery system for Medicaid in most states including California. A total of 39 states, including California, have managed care contracts, and California is one of 19 states with Primary Care Case Management (PCCM), a fee-for-service system where beneficiaries get primary care along with case management from providers for a small fee, according to the report.

In California, 77% of Medi-Cal beneficiaries are in managed care plans, according to the report.

California is one of seven states with a hospital Delivery System Reform Incentive Payment (DSRIP) program, in which safety-net hospitals receive payment incentives in exchange of achieving pre-set quality, care coordination and access milestones. New Hampshire and Washington states are seeking approval to launch similar programs, according to the report.

Ten states have all-payer claims databases, which can be a valuable tool to identify areas for reform. California and Washington state plan to launch all-payer claims databases in fiscal year 2016, according to the report.

Related Topics

Capitol Desk Medi-Cal The Health Law