Tag: Medicaid
This edition examines the impact of Medicaid Expansion on prescription drug access, comparing prescription volume trends in 18 states that expanded Medicaid in 2014 with six non-expansion states. We look at overall prescription volume as well as three specific therapeutic classes of drugs: antidepressants, insulin, and bronchodilators.
Over the 10-year timeframe 2014-2023, we estimate that Medicaid Expansion led to nearly 1.2 billion additional prescriptions across the 18 states, representing a 56% increase in overall Medicaid prescription volume. In 2023, the pre-rebate cost per Medicaid prescription averaged $136, or over $1,600 annually per medication. Given the cost and the fact that over 80% of new Expansion enrollees were previously uninsured (and all had low income), these medications would largely have been inaccessible/unaffordable without Medicaid Expansion.
- Keywords: Expansion Medicaid Prescription Drugs
This edition provides an overview of the PACE model, which delivers comprehensive, community-based care for adults aged 55+ who need nursing home-level of care. As of March 2025, 184 organizations operate over 300 PACE centers in 33 states and DC, serving 82,000 participants—most of whom are dually eligible and medically complex. PACE enrollment has grown 53.1% since 2020, far outpacing the 6.3% growth in the 55+ population. Most PACE programs are operated by standalone PACE organizations, larger health systems, long-term care organizations, and FQHCs. There are opportunities for geographic and operational expansion, though barriers to scalability remain.
This edition provides information on Medicaid’s fiscal redistributional dynamics. For example, during FFY2023 Trump-won states collectively gained $16.8 billion between the amounts residents of these states contributed to Medicaid (via their Federal and state taxes) and the level of Medicaid spending that took place in their states.
- Keywords: Medicaid
5 Slide Mini-Series Edition #2: Medicaid Coverage Renewals and Terminations– Overview and Key Trends
The second edition of our Medicaid Unwinding and Redeterminations 5 Slide Mini-Series explores Medicaid coverage renewal outcomes across states during the unwinding period (March 2023- July 2024).
- Keywords: Enrollment Medicaid Redeterminations Unwinding
This first edition of our Medicaid Unwinding and Redeterminations 5 Slide Mini-Series provides an overview of Medicaid eligibility and enrollment trends during and after the COVID-19 public health emergency (PHE).
- Keywords: Enrollment Medicaid Redeterminations Unwinding
This edition delves into NCQA’s Medicaid health plan overall quality ratings for performance years 2022 and 2023. A key component of our analyses involved creating enrollment weighted average scores for the Medicaid health plans operating in multiple states, and similar average scores across the health plans serving Medicaid in each state.
This report explores which prescription drug model is best suited for Washington’s Apple Health (Medicaid) program: the current carve-in prescription drug model, under which managed care organizations (MCOs) pay for members’ prescriptions, or a carve out model, where prescriptions are managed by a separate company using a fee-for service (FFS) payment mechanism. Our overall recommendation is that Washington should preserve the carve-in pharmacy model for the Medicaid program
This edition focuses on Medicaid MCO procurements, an area where our company conducts vast project work. We describe a few actions states can take to get the most value out of their procurements. We also offer some thoughts regarding how states can better overcome a protest process that seems to have become increasingly problematic.
- Keywords: Medicaid Procurement
This 5 Slide Series edition provides our tabulations and analysis of NCQA’s Quality Ratings for Medicaid MCOs juxtaposed with the specialized accreditations NCQA has awarded to these health plans.
This 5 Slide Series edition provides our tabulations and analysis of the NCQA Quality Ratings for Medicaid MCOs (Rating Year 2022-2023).