HSA 5200 RU Medicaid Expansion Approach Recommendations Advocacy Report

Competency

Discuss the role and impact of lobbyists, special interest groups, and other consumer advocates on the development of healthcare policies in the U.S.

Scenario

You are the director of community affairs for the health lobby organization Pathways to a Healthy America. In 2010, President Barack Obama signed the Affordable Care Act into law. As a result, millions of Americans who were previously uninsured gained access to the healthcare system. One of the initial provisions of the Act required individual states to expand the eligibility criteria for Medicaid. The program’s costs would be absorbed by the federal government at a rate of 100% for the first three years of program participation which would decrease to 90% after 2020, still, considerably higher than previous funding by the federal government. However, in 2012, the Supreme Court ruled the mandate unconstitutional allowing individual states to voluntarily “opt” out of the Medicaid expansion program. As a result of the various states’ decision to “opt” out of the ACA’s Medicaid expansion, millions of adults fell into the critical coverage gap. Your organization represents a state that has decided to forego participation in the ACA expansion program. The decision was met with both praise and criticism.

It has now been a few years since the decision, and your organization has gathered information on the impact of the decision to advocate for Medicaid reform during the next state legislative session.

You are required to write an advocacy report to state lawmakers in which you advocate for either participating in the original expansion program or participating with conditions (waivers) to address the critical gap in coverage for vulnerable adults in your state. Waivers such as Section 1115 enable for alternative implementation of Medicaid expansion and allow states to impose restrictions that may result in a denial of Medicaid eligibility for individuals who do not meet those restrictions, i.e., work requirements.

Instructions

Research the Medicaid expansion program offered through the Affordable Care Act (ACA) and Medicaid reform initiatives using waivers to increase access to Medicaid. Based on your state’s (Illinois) profile, determine which process (the ACA’s expansion program or waivers) is most beneficial to your state. Include a comprehensive, well-supported recommendation for participation in Medicaid reform using either the ACA’s program or a modified reform process using waivers.

Your advocacy report should describe your state’s (Illinois) current Medicaid program, including its eligibility criteria, demographics, Medicaid spending and savings since the ACA’s implementation, and comprehensive details of current or pending waivers. You should also include a discussion (benchmark) on another state’s success with Medicaid reform using your recommended strategy (the ACA’s expansion program or the use of the specific types of waivers for which you propose).

Resources

You will find an attached PDF containing information from the Commonwealth Fund.

You will find a PDF containing information from the Kaiser Family Foundation on Medicaid Expansion using this link Status of State Action on the Medicaid Expansion Decision | KFF