Medicaid and CHIP Risk-Based Managed Care in 20 States. Experiences Over the Past Decade and Lessons for the Future.. The Affordable Care Act


The Affordable Care Act, passed on March 23, 2010, includes unprecedented expansions in access to health coverage starting in 2014; it also mandates that most Americans have health insurance beginning in that year. The Affordable Care Act’s two primary means of expanding coverage are (1) an expansion of Medicaid to all individuals under age 65 and not enrolled in Medicare, with family incomes under 138% of the federal poverty level (FPL); and (2) establishment of a tax credit subsidy program to help individuals in the individual and small group markets with family incomes up to 400% of FPL obtain coverage through new Health Insurance Exchanges. The Affordable Care Act will lead to a large influx of enrollees into Medicaid, primarily consisting of adults who are newly eligible for the program. Estimates suggest that about 16 million newly eligible people will enroll in Medicaid or CHIP by 2019 because of the Affordable Care Act (Holahan & Headen, 2010). Given the prevalence of managed care for existing Medicaid enrollees, most Affordable Care Act expansion enrollees are likely to be enrolled in risk-based managed care programs in 2014. In some states, this new influx may cause strains on the MCOs and their associated providers, as they try to serve many new beneficiaries with unmet health needs.

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