Alternative Models of Medicaid Expansion: Assessing State Strategies in Indiana, Michigan, Ohio, and Kansas

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This work will build on previous groundbreaking research conducted by Harvard's Ben Sommers and his team. The researchers led a four-year survey of low-income adults in three Southern states: Kentucky, which expanded Medicaid consistent with the Affordable Care Act; Arkansas, which took an alternative approach to expansion through a 1115 federal waiver; and Texas, which has declined to expand. The study provided invaluable evidence on the impact of the Medicaid expansion, finding that it has been effective in improving the health care and health status of low-income Americans. The project team will now shift its focus to the Midwest in assessing the effects of 1115 waivers. Similar federal evaluations have lacked rigor and have not made comparisons between states. Sommers and his team will assess insurance coverage, access to care, and satisfaction with coverage and care in three Midwestern states that have taken different approaches to Medicaid expansion: Indiana, which uses an 1115 waiver expansion with distinctive features; Ohio, which expanded as prescribed by the ACA; and Kansas, which has so far declined but is debating expansion. The study will use a similar sampling frame and survey instrument as in the past, with additional follow-up questions for the subset of individuals enrolled in Medicaid waiver states, as well as uninsured adults in those states. If the team secures cofunding, SSRS will expand the study to include a fourth state: Michigan, which expanded through an 1115 waiver. This project will provide federal and state policymakers with evidence of the effects of different state approaches to Medicaid expansion, including how specific aspects of 1115 waivers influence consumers' experiences with coverage and whether they have dissuaded uninsured individuals from enrolling. With state legislators and members of Congress considering major changes to Medicaid to allow greater state flexibility, these survey findings will provide an empirical basis for informed decision-making.

Grant Details

Grantee Organization:
President and Fellows of Harvard College
Principal Investigator:
Benjamin Sommers, M.D., Ph.D.
Award Amount:
$590,000.00
Approval Date:
July 11, 2017

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