Publications on Medicaid

As many as 10 million older Americans and younger adults with disabilities require long-term care, either at home or in nursing facilities. The United States spends more than $200 billion annually for such care. However, our system for financing this assistance-principally Medicaid and family assets, with a small share funded through private insurance—may be untenable as baby boomers age. TPC's Howard Gleckman looks at the way we deliver and pay for these services in a new book, Caring for Our Parents: Inspiring Stories of Families Seeking New Solutions to America's Most Urgent Health Crisis. He and a panel of top policy experts will discuss how—or whether—long-term care should be included in health reform legislation.

Urban Institute researcher Sharon Long answers five questions about Massachusetts's landmark health reform experiment, which aims for near-universal coverage and improved access to affordable health care. In 2006, lawmakers passed a bill that required most adults to get health insurance, expanded Medicaid, provided subsidies for lower-income adults, created a health insurance exchange where residents can buy plans easily, and required employers to offer coverage or pay a fee. Early success has made the state a model for nationwide reform.

This Urban Institute study, with partner the National Academy for State Health Policy, presents findings from a 50-state analysis of Medicaid outreach and enrollment strategies targeting pregnant women. The study finds significant variation across states, but observes that the majority have policies to facilitate pregnant women's access to coverage through simplified enrollment; however, there is considerable room for improvement in outreach efforts and enhanced prenatal care. The paper presents policy recommendations for state officials to facilitate enrollment of pregnant women, raise public awareness of available coverage, and broaden the scope of prenatal care. The March of Dimes funded this study.

This brief examines the potential effects of health care reform on the more than 25 million children who currently have coverage under Medicaid or the Children's Health Insurance Program (CHIP). Increased parental coverage will help these children since many have uninsured parents with unmet health needs. However, proposals to move these children into a new health insurance exchange could make them worse off through the potential loss of benefits and legal protections and possible exposure to higher cost-sharing; alternatively, if reimbursement rates are higher in the exchange than paid under Medicaid and CHIP, children's access to providers could improve.

Medicaid provides a strong platform on which reform efforts to expand health insurance coverage can be built as two-thirds of the nation’s uninsured are low-income. Medicaid coverage could be broadened to reach more of the low-income uninsured by eliminating categorical restrictions and establishing a national eligibility standard based on income. This paper analyzes several options for expanding Medicaid using various income eligibility thresholds for adults and children under both current and enhanced participation rates. The analysis shows coverage and cost implications of the options, as well as impacts by region and with payment rates adjusted to promote provider participation.