Monday, October 20, 2014 Medicaid Programs in Period of 'Significant Change,' Expansion in Most States "Transformative" changes mandated by the Affordable Care Act (ACA) and a slowly recovering economy have contributed to a Medicaid system in which most states are expanding eligibility, adopting delivery system reforms, and increasing community and home-based services, according to a new study from Kaiser Commission on Medicaid and the Uninsured. The Kaiser report surveyed Medicaid directors in all 50 states and the District of Columbia to gather information on program changes implemented in the 2014 fiscal year or planned for the next year. Authors of the study write that these years "will stand out as a time of significant change and transformation." Among the findings: As of September 2014, 28 states have moved ahead with Medicaid expansion provided under the ACA; 4 states reported eligibility restrictions. Alaska, Connecticut, and Wyoming are the only states that did not report using some form of managed care, including managed care organizations (MCOs), primary care case management, or a combination. Implementation or expansion of Medicaid health homes was reported by 26 states. States continued to expand the number of individuals served in home- and community-based services, with 47 states reporting growth in this area in FY 2015. While the Kaiser report shows more variation in how states are adjusting provider rates, authors note that generally "more states implemented provider rate increases across most major provider types … inpatient hospital rates being the exception." "States are expanding their reliance on managed care but also implementing new innovative delivery systems and care coordination arrangements, some of which are new options made available by the ACA," according to the authors. In turn, this expansion could be putting some programs to the test, with most directors "report[ing] staffing and resource constraints in the face of the magnitude of the changes occurring in the program today." Keep up with Medicaid as it continues to evolve: check out APTA's Medicaid webpage for resources, including a members-only guide titled "Making Sense of Health Care Reform: Medicaid Expansion."