Friday, December 6, 2013

More on Medicaid Expansion under the Affordable Care Act

Governing has published two interesting articles that look at the impact of Medicaid expansion under the ACA.  The first, by Chris Kardish, published November 26, 2013, covers the impact of Medicaid expansion on prison health care costs.  How Medicaid Expansion Can Lower Prison Costs, Recidivism starts by noting one of the benefits of the ACA's Medicaid expansion: " the chance to save millions on health care in prison systems and lower the number of ex-convicts who commit new crimes."

Those states expanding Medicaid can ask the federal government to cover those hospitalizations outside the prison system, and although that has been true for some time, the prisoner-patients would not have qualified for Medicaid prior to the expansion.  Not only is there an impact on the current prison population but "[b]acked by studies that show access to mental health, substance abuse and other services help keep former prisoners from committing crimes again, some states are taking extra steps to ensure ex-prisoners not only sign up for Medicaid but keep their appointments." Not only will states save money, but the recidivism rates will drop, according to studies referenced in the article.  The article has some interesting statistics and discusses the experiences of several states.

The second was also by Chris Kardish and published December 2, 2013.  New Medicaid Enrollees Come with Mental Health Needs, Uncertain Costs discusses a recent study done by the Harvard School of Public Health and the Urban Institute, using interviews from Medicaid directors in states that had already expanded Medicaid coverage. The report, Lessons From Early Medicaid Expansions Under Health Reform: Interviews with Medicaid Officials is published in Medicare and Medicaid Research Review, and is authored by Benjamin D. Sommers, Emily Arntson, Genevieve M. Kenney and Arnold M. Epstein. 

According to the story in Governing, the hardest part was predicting with any certainty the numbers who would sign up, the costs and the services needed, in particular, mental health care. Officials were surprised by the cases of substance abuse, which did not qualify the beneficiaries for coverage prior to the expansion. The article notes the conclusion that states should find a way to expand coverage for mental health as well as include it in primary care. A pdf of the report may be downloaded here.

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