Alternatives to Medicaid Expansion: What States Are Doing

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Following the Supreme Court’s ruling that states could decide for themselves whether to expand eligibility for Medicaid under the Affordable Care Act, a number of states have opted to do so using alternative approaches. Under federal waiver, these states have focused on expanding the use of private health insurance, requiring beneficiaries to pay premiums, and incentivizing them to choose cost-effective care.<br /><br />
In a new Commonwealth Fund issue brief, George Washington University’s Sara Rosenbaum and Carla Hurt examine the variety of Medicaid reforms that Arkansas, Michigan, Iowa, and Pennsylvania are currently testing. By linking broader program reforms to the adult coverage expansion, these states can align Medicaid with local political conditions while extending insurance to more than 1 million adults who would otherwise lack a pathway to coverage.<br />
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As additional states choose Medicaid expansion alternatives, it will be important, the authors say, to rigorously evaluate the changes, including the impact of increased cost-sharing and reduced benefits on access to care and the effectiveness of consumer incentives to change health behaviors. Read the brief