Section 1115 Medicaid expansion waivers: implementation experiences : findings from structured interviews in Arkansas, Indiana, Iowa, & Michigan : final report
- Collection:
- Health Policy and Services Research
- Author(s):
- Zylla, Emily, author Planalp, Colin, author Lukanen, Elizabeth, author Blewett, Lynn, author
- Contributor(s):
- State Health Access Data Assistance Center, University of Minnesota, issuing body.
- Publication:
- [Minneapolis, Minnesota] : State Health Access Data Assistance Center, University of Minnesota, February 8, 2018
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Health Behavior Health Care Reform -- organization & administration Medicaid -- organization & administration Organizational Case Studies Communication Cost Sharing Deductibles and Coinsurance Emergency Service, Hospital Facilities and Services Utilization Health Insurance Exchanges -- economics Health Services Accessibility Managed Care Programs Medical Informatics Medical Savings Accounts Personnel Staffing and Scheduling State Government Humans Arkansas Indiana Iowa Michigan United States United States.
- Genre(s):
- Technical Report
- Abstract:
- Since the implementation of the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) in 2014, 33 states have expanded their Medicaid programs to certain non-disabled adults. Twenty-five of these states expanded through a traditional approach as envisioned by the ACA, and eight states expanded coverage through an alternative approach allowed under Section 1115 of the Social Security Act. Many states see these alternative approaches to expansion as a politically viable way to expand coverage to low-income adults. The completion of a state-led evaluation is a mandatory component of Section 1115 waivers. In many cases, the Centers for Medicare & Medicaid Services (CMS) also sponsor state-specific and cross-state evaluations. These evaluations typically focus on the impact of the waiver provisions on program costs and beneficiary experiences, however questions related to implementation are beyond the scope of required evaluations. In addition, to date, the current evaluations lack detail on whether states implemented all provisions of their waivers as initially planned. Information about the administrative burden, related financial costs, and states' experiences in implementing their 1115 waivers is important for state and federal policymakers. Assessing 1115 waivers through this lens could help policymakers interpret the evaluation results from current waiver states, aid in decisions about whether to pursue specific waiver provisions, and inform the design and implementation of these waivers moving forward. The purpose of this study was to understand how the states of Arkansas, Indiana, Iowa, and Michigan have approached the development, implementation, and management of innovative waiver policies, and to provide insight into implementation-related issues such as the following: (1) What administrative (e.g., staffing, interdepartmental communication, IT systems, etc.) elements were needed to implement the policies? (2) What expected and unexpected challenges arose? (3) How did states respond to challenges? What solutions worked, or how did they adapt their policies? (4) What considerations should other states take when designing and implementing waivers? To address these questions, SHADAC conducted interviews with 33 individuals representing current and former state agency staff and health insurance carriers involved in waiver program implementation in the study states. The following report provides background information on the waiver program elements implemented in each of the four study states, and summarizes the state administrative capacity needs as well as the challenges faced. It also presents the key themes identified through discussions with study interviewees. Additional detailed information on the study methods and interview guides can be found in Appendices A and B, respectively.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (i, 43 pages, A2, B10))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101738647 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101738647