Tag: Medicaid
The purpose of this study is to compare the US states that have adopted the Affordable Care Act’s (ACA) Medicaid Expansion to the states that have not done so. The Medicaid Expansion makes people with incomes up to 138 percent of the federal poverty (FPL) line eligible for Medicaid. The US Supreme Court ruling in June 2012 made the Medicaid Expansion, originally intended to be nationwide, optional for states. To date, 37 states and the District of Columbia have implemented this Expansion.
We compare a group of states that adopted the Medicaid population, excluding a few states that had, pre-ACA, already covered most or all of this Expansion population, to those states that had not adopted this Expansion through the end of 2019. We compare these groups of states across the Medicaid Expansion timeframe that was available for analysis (typically 2014-2019). Some of the key components of our assessment included:
• Health Coverage — particularly impacts on the size of the uninsured population
• Medicaid Costs – overall and at the state and federal level
• Deaths in the under-65 population
• Employment Levels and Unemployment Rates
This study is an objective analysis of the observed impact of Medicaid Expansion on the number of uninsured, Medicaid costs to both states and the federal government, deaths, employment, hospitals’ financial situation, and other key outcomes. The intent is to help inform the states that have not yet implemented the Expansion about its likely impact, as well as to demonstrate for Expansion states the aggregated impacts that have occurred.
Virginia began implementing a Common Core Formulary within its Medicaid managed care program in 2017 for CCC Plus members and in 2018 for Medallion 4.0 members. The Virginia Association of Health Plans (VAHP) engaged The Menges Group to analyze the fiscal and programmatic impacts of this policy change. Our tabulations indicate that the change to the Common Core Formulary led to increased net (post-rebate) Medicaid costs of $13.2 million during calendar year 2019, including $5.5 million in additional state funds.
Some Virginia policymakers have indicated an interest in moving to a pharmacy “carve-out” within the Medicaid managed care program, whereby the state would instead manage the pharmacy benefit for MCO enrollees, including paying directly for drugs made available in the program. Virginia’s Association of Health Plans engaged The Menges Group to estimate the fiscal impacts of Virginia switching to a carve-out model as well as the programmatic advantages and disadvantages of this potential change. We estimate that a change to a pharmacy carve-out would result in a 20.2% increase in net (post-rebate) Medicaid pharmacy expenditures across the five year timeframe SFY2020 – 2024, increasing net state fund costs by $12 million in the first year of implementation and by $157 million over five years.
PCMA engaged The Menges Group to estimate the financial and programmatic value of managing the prescription drug benefit in the Medicaid managed care setting, comparing states that utilize MCOs – who contract with PBMs – for their prescription drug benefits to states that manage their prescription drug benefits in FFS. Using Medicaid prescription drug data reported by each state to the Centers for Medicare and Medicaid Services (CMS) for all Medicaid-paid pharmacy-dispensed prescriptions, we analyzed how prescription drug costs and usage vary depending on how prevalent managed care is in each state Medicaid program. We also analyzed the drug costs and usage within specific therapeutic drug classes.
America’s Health Insurance Plans (AHIP) engaged The Menges Group to assess West Virginia’s Medicaid pharmacy carve-out impacts, analyzing the findings of another consulting firm’s report. Our analyses suggest that West Virginia’s carve-out has created increased Medicaid expenditures rather than savings. We also provide a large volume of evidence from states that switched to a carve-in approach (comparing their cost per prescription progression to states that maintained their carve out model). These results, taking into account all Medicaid pharmacy claims and rebates in 13 states and across a several year comparison timeframe, compellingly indicate that the carve-in model has yielded large-scale savings relative to the carve-out approach.