navigating the medicaid reform landscape (medicaid reform info graphic)

© ICF International 2014

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CENTER FOR MEDICARE & MEDICAID INNOVATION

ACCOUNTABLE CARE ORGANIZATIONS

COMMUNITY BASED SERVICES

5 MILLIONPOOR UNINSURED ADULTS WILL FALL INTO THE “COVERAGE GAP”

THE COVERAGE GAP

HAVE YET TO EXPAND MEDICAID, PREVENTING

24 STATES

5.7 MILLION PEOPLE FROM OBTAININGHEALTH INSURANCE COVERAGE IN 2016

CID GRA 0714 0165

PRIVATE SECTOR DELIVERY OF MEDICAID PROGRAMS

The Medicaid Reform DynamicThere’s no doubt about it: The Medicaid Dynamic is revolutionizing healthcare delivery on a national scale. With private sector companies at the heart of Medicaid service delivery, they hold the keys to the majority of the infrastructure feeling the impact of reform. These private stakeholders over the next decade will help drive the definition and delivery of the reform landscape. ICF helps to navigate the private sector road to healthcare reform, unlocking optimal solutions and best practices to meet these challenges—with the Healthcare Delivery Series.

Sources (confirmed as of May 2014)Centers for Medicare and Medicaid Services (CMS), Kaiser Foundation website: kff.org/medicaid/issue-brief/how-is-the-aca-impacting-medicaid-enrollment/Kaiser Foundation website: kff.org/medicaid/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/Kaiser Foundation website: kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/ Kaiser Foundation website: kff.org/medicaid/fact-sheet/state-demonstration-proposals-to-integrate-care-and-align-financing-for-dual-eligible-beneficiaries and kff.org/medicaid/state-indicator/duals-share-of-medicaid-spending/ Kaiser Foundation website: kff.org/health-reform/issue-brief/individual-market-enrollment-ticks-up-in-early-2014/ CHCS Issues Brief from January 2014: chcs.org/media/Churn_1_30_2014_final.pdf FierceHealthPayer article by Dina Overland, July 3, 2014: fiercehealthpayer.com/story/white-house-continues-pressure-states-expand-medicaid/2014-07-03

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SYSTEMS INTEGRATION & MANAGEMENT

CUSTOMER KNOWLEDGETECHNOLOGY

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KEY SUCCESS FACTORS TO DELIVERY SYSTEM REFORM

THE ROAD TO HEALTHCARE REFORM

DID YOU KNOW… Medicaid Reform Fast Facts

COORDINATING CARE FOR DUAL ELIGIBLES

MEDICAID PAYMENT DEMONSTRATION PROJECTS

NEW ACA-INFLUENCED MEDICAID PROGRAMS

EXPANDED MEDICAID COVERAGE

HEALTH INSURANCE MARKETPLACE

7 MILLION ARE LIKELY TO EXPERIENCE COVERAGE SHIFTS BETWEEN MEDICAID AND MARKETPLACE POLICIES ANNUALLY

$96 MILLION AMERICANS ARE ELIGIBLE TO RECEIVE MEDICAID OR MARKETPLACE SUBSIDIES

29 MILLION ARE LIKELY TO “CHURN” BETWEEN ALL COVERAGE OPTIONS

STATE MEDICAID EXPANSION

IMPLEMENTING EXPANSION IN 201427OPEN DEBATES3NOT MOVING FORWARD AT THIS TIME21

4

IN 2010, DUAL ELIGIBLES ACCOUNTED FOR

28% – 41%OF MEDICAID SPENDING FOR OVER 25 STATES

DUAL ELIGIBLES9 MILLION

MEDICAIDMEDICARE

BETWEEN

3.3–4.2 MILLIONPEOPLE HAVE SIGNED UP FOR MARKETPLACE COVERAGE AS OF FEBRUARY

PEOPLE HAVE INDIVIDUAL MARKET COVERAGE AS OF MARCH 2014

15 MILLIONABOUT

Healthcare Delivery Series

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MEDICAID

From exchange implementation to maintaining federal mandates, and enrollment streamlining to care coordination—sustainable yet adaptable systems are key.