As Medicaid remains dynamic and evolving, 2019 is likely to see many changes in the program. Medicaid provides health and long-term care coverage to more than 70 million low-income children, pregnant women, adults, seniors, and people with disabilities in the United States. Some of the trends include ways to instantiate improved strategies for patient engagement and healthcare access across the United States.
Improving the patient experience, and the impact of technology transformation
Medicaid providers and payers share a heightened focus on providing better customer service to patients which will likely continue in upcoming years, emphasizing the ability technology has to transform healthcare delivery. Both Medicaid and commercial insurance members will pay more out-of-pocket for their care, resulting in higher expectations when it comes to their providers and payers.
These higher expectations also mean members will be more willing to shop around until they receive good value and service. Consumerism is increasing the competitiveness in the marketplace. With big tech players entering the healthcare marketplace and their solutions beginning to gain popularity, there will be increased pressure on existing providers and payers to boost patient satisfaction and deliver improved customer service.
Stabilization of ACA exchange plans
The 39 states that use the federal Healthcare.gov website to enroll citizens in Medicaid plans saw an average premium decrease of 0.83%, broken down in the following way:
- 19 states saw a decline in average premiums.
- 13 states had small increases of between 0-5%.
- Six states (including Washington DC) experienced double-digit increases.
Vermont saw the greatest increase with 23.17%, while in Tennessee, average premiums decreased 26.24%. Premiums in many states have risen between 100% and 200% since 2014. Some argue that these arrestingly high premiums are the result of the Trump administration’s efforts to roll back provisions of Obamacare, including the individual mandate, and the expansion of short-term plans.
The Kaiser Family Foundation has put forth evidence that these actions actually did increase premiums, and the decreases are due to other factors. Their primary argument is that the large increases seen since 2014 have simply made the plans profitable enough for the insurers that they can afford to reduce the premiums. Kaiser research indicates that without the Trump Administration's changes to the ACA, premiums would have, on average, dropped 16% more than they did.
The “Medicaid buy-in” concept is evolving
The concept of Medicaid buy-in is evolving, encompassing the original Medicaid-based proposals and extending to other programs through which states can leverage government bargaining power to offer a more affordable coverage option, like state employee health plans or a Basic Health Program. Some also label it a “public option,” particularly for state-sponsored plans in the Marketplace. Buy-in program design can vary significantly and can be tailored according to a state’s policy objectives, the target population, and local market dynamics. Emerging buy-in models include:
- Off-Market Buy-In: The State makes coverage available to consumers who are not eligible for Medicaid as a state-sponsored buy-in plan that leverages the Medicaid program or state employee health plan (SEHP); offered outside the individual market or Marketplace.
- On Marketplace Buy-in/Public Option: The State offers a state-sponsored qualified health plan (QHP) on the Marketplace leveraging Medicaid infrastructure; potentially in partnership with an existing managed care plan (if applicable).
- Basic Health Program Buy-In: The State offers a Basic Health Program (BHP) to individuals with incomes below 200% of the federal poverty line (FPL) who are not Medicaid-eligible; and allows individuals with higher incomes to buy-in to the program.
These modifications will pose as both a challenge and an exciting opportunity for Medicaid administrators throughout the United States. Differing viewpoints among Democrats and Republicans, and the current divisions in the split Congress, convey that it is crucial that all stakeholders work together to create a viable healthcare system for all.