1 Healthcare Reform Medicaid Provisions and Opportunities Legal Action Center

2 Medicaid in Healthcare Reform Reform expands Medicaid eligibility to almost everyone up to 133% FPL, will extend coverage to a large number of uninsured adults All newly-eligible adults to be guaranteed coverage for SUD/MH The federal government will pay a very large share of the costs of the expansion

3 Medicaid Coverage Expansion Prior to reform, Medicaid offered broad based coverage to children and pregnant women; coverage for parents was more limited and coverage for childless adults generally prohibited States can expand to all under 133% FPL now and will be required to by 2014  Early adopters can do so with state plan amendment and will receive current FFP  States can phase in expansion but must use same income eligibility level for all newly-eligibles and expand to lower income groups before higher-income groups  No asset tests and newly-eligible parents can enroll only if their children also have health insurance

4 Medicaid Benefits for Newly-Eligible Adults States must provide benefits to newly-eligible adults through “benchmark” structure  States choose benefits plans that are actuarially equivalent to FEHBP, state employees’ plan, largest HMO in the state, actuarial equivalent of any of these plans, or Secretary-approved coverage  Benchmarks are generally more limited than traditional Medicaid, but must meet minimum benefit requirements of the exchange –Includes SUD/MH benefits at parity  Appears that states will be able to make their existing Medicaid package available to newly-eligibles through Secretary-approved option

5 Enhanced Federal Financing for Medicaid Expansion The federal government will pay a very large share of Medicaid expansion costs States will receive 100% FFP for , 95-93% FFP for , and 90% FFP for 2020 and subsequent years States that have already expanded eligibility to childless adults up to 100% FPL will receive phased-in increase in FFP until all states receive the same rate in 2019

6 Opportunities Related to Medicaid Expansion Childless adults eligible for the first time Large increase in coverage in return for small increase in state funding An estimated 16 million previously uninsured individuals will enroll, receive good SUD/MH benefits

7 Recommendations Related to Medicaid Expansion States will continue to have significant flexibility to design benefits  Critical need to work with Medicaid offices to ensure the richest possible benefits We will continue to work on the national level; need your feedback from the state level to inform national efforts Need for education and outreach to enroll newly (and current) eligibles Substance use disorder treatment continues to be an optional Medicaid service for traditional adult beneficiaries; push needed in many states to ensure all beneficiaries receive good addiction coverage