How Are 1115 Waiver Alternatives to Traditional Medicaid Expansion Working Out?


The political debate around Medicaid has shifted from whether to expand eligibility for the program to how to expand it. For instance, Arkansas has used Medicaid funds to buy beneficiaries private coverage through the Affordable Care Act’s insurance marketplaces, while other states are planning to introduce requirements for work or community service.

In a Commonwealth Fund–supported study in Health Affairs, Benjamin Sommers, M.D., and colleagues at the Harvard T. H. Chan School of Public Health surveyed low-income adults in three Midwestern states with different Medicaid policies: Indiana, which used a waiver to expand Medicaid and introduced health savings accounts; Ohio, which expanded eligibility for traditional Medicaid; and Kansas, which has not expanded Medicaid but is considering doing so with work requirements.

The researchers find that health savings accounts and work requirements may not produce the results that state policymakers are aiming for. The authors estimate that confusion about health savings accounts in Indiana places as many as two-thirds of the enrollees at risk of losing some of their benefits or being locked out of the program altogether. In Kansas, work requirements may have modest effects on job-searching behavior but may not change the likelihood of employment for the majority of residents who might enroll were the state to expand Medicaid.

Alert_Paying_for_Care Read about the study