January 2013
New Hampshire Department of Health & Human Services (DHSS)
Lewin contact: Randy Haught
As a result of the June 2012 Supreme Court ruling that the federal government cannot require individual states to expand their Medicaid programs for adults under the Affordable Care Act (ACA), The Lewin Group is working with the New Hampshire Department of Health and Human Services (DHHS) to explore the potential financial impacts of expanding or not expanding the state’s Medicaid program.
Phase I of the study, released in November 2012, analyzes Medicaid enrollment and costs under the option of not expanding Medicaid compared to the option of expanding the program under various program design options. We find that if the state does not expand Medicaid, it could reduce state Medicaid spending by $66 to $114 million over the 2014-2020 period. However, expanding Medicaid would (1) reduce the number of uninsured in the state by an additional 22,300 people, (2) provide subsidized coverage for low income adults in the state, who would not have access without the expansion, and (3) increase federal revenues in the state by $1.8 to $2.7 billion over the 2014-2020 period.
This report represents Phase II of the study, where we estimate the secondary effects of expanding versus not expanding Medicaid in the state. We estimate the impact of Medicaid expansion versus no expansion on other state programs, the uninsured, various provider groups, the state economy, and the commercial market. Here, we find that deciding to expand or not expand Medicaid in New Hampshire will have impacts beyond the state’s Medicaid program itself. If expanding Medicaid under a fee-for-service program, the state will see offsets (savings) to other state programs totaling $67.1 million from 2014 to 2020, reducing the total cost of expanding Medicaid to $18.4 million over this period. If expanding Medicaid under a managed care program, the state would save $47.1 million from 2014 to 2020, compared to projected costs without the ACA.
Phase II findings also indicate that the ACA will have a measurable, positive impact on the state economy at large, and expanding Medicaid will maximize this impact. The impact on the uninsured, on providers, and on the commercial market should also be considered, as the decision to expand Medicaid affects these stakeholders and subgroups in different ways.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
November 2012
Health Strategies of New Hampshire
Lewin contact: Randy Haught
As a result of the June 2012 Supreme Court ruling that the federal government cannot require individual states to expand their Medicaid programs for adults, as under the Affordable Care Act (ACA), The Lewin Group is working with the New Hampshire Department of Health and Human Services (DHHS) to explore the potential financial impacts of expanding or not expanding the state’s Medicaid program. This report provides estimates on Medicaid enrollment and costs under the option of not expanding Medicaid compared to the option of expanding the program under various program design options. We find that if the state does not expand Medicaid, it could reduce state Medicaid spending by $66 to $114 million over the 2014-2020 period. However, expanding Medicaid would (1) reduce the number of uninsured in the state by an additional 22,300 people, (2) provide subsidized coverage for low income adults in the state, who would not have access without the expansion, and (3) increase federal revenues in the state by $1.8 to $2.7 billion over the 2014-2020 period.
In Phase II of the study, to be released in December 2012, Lewin will estimate the secondary effects of expanding versus not expanding Medicaid in the state. This will include the impact of additional federal revenues on the state economy if the state expands Medicaid, the impact on spending for other state programs, the impact on Medicaid Disproportionate Hospital Share (DSH) payments and provider uncompensated care, the financial impact on health care providers, and the potential impact on cost shifting and its effect on commercial premiums.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP, Health Reform
June 2011
Expertise Area: Health Reform, Medicaid and CHIP
May 2011
Pennsylvania Coalition of Medical Assistance Managed Care Organizations
The Pennsylvania Coalition of Medical Assistance Managed Care Organizations (the Coalition) represents Pennsylvania’s Medical Assistance physical health managed care organizations that participate in the state’s HealthChoices program. Health Choices is the state’s large-scale capitated mandatory managed care program for Medical Assistance recipients. In 2005, the Coalition commissioned The Lewin Group to conduct a comparative evaluation of Pennsylvania’s HealthChoices program to the state’s traditional fee-for-service program as well as ACCESS Plus, the state’s enhanced primary care case management program, focusing on cost-effectiveness, impact on access, the quality of services provided, and the program’s focus on and approaches to serving individuals with special needs. In 2011, the Coalition asked Lewin to update the cost-effectiveness piece of the 2005 study in an effort to identify savings provided to Pennsylvania by HealthChoices when compared to traditional fee-for-service and to ACCESS Plus.
Client Area: Associations
Expertise Area: Medicaid and CHIP
February 2011
Sponsored by: Medicaid Health Plans of America
Thirteen states use a pharmacy carve-out model in their Medicaid managed care programs. This report assesses the policy option of these states moving to a pharmacy carve-in approach, quantifying the expected savings in each state and exploring the programmatic dynamics of the two alternatives. The report finds that large-scale savings are likely to occur in most of these 13 states by switching to the carve-in approach.
Expertise Area: Medicaid and CHIP
February 2011
Lewin has estimated the savings that Medicaid programs could achieve in each state through optimal management of the pharmacy benefit. Our estimates take into account each state’s baseline dispensing fees, ingredient costs, brand/generic mix of drugs, and the overall volume of prescriptions occurring in the fee-for-service (FFS) setting. Specific assumptions are made in each of these areas to derive each state’s potential savings. Across the ten-year timeframe 2011-2020, we estimate that total nationwide Medicaid savings of $30.3 billion could occur through optimal management of each state’s Medicaid FFS prescriptions.
Expertise Area: Medicaid and CHIP
December 2010
Lewin contact: John Sheils
In this study, we focus on the impact of The Affordable Care Act of 2010 on state spending for Medicaid and the Children’s Health Insurance Program (CHIP).
Expertise Area: Health Reform, Medicaid and CHIP
November 2010
The Medicaid Institute at United Hospital Fund
This paper describes New York's program for providing transportation services to Medicaid beneficiaries, considers the strengths and weaknesses of the state's program, and assesses alternative approaches to improve the program and reduce costs.
Client Area: Foundations
Expertise Area: Medicaid and CHIP
October 2010
Citizen's Budget Commission
The Citizen’s Budget Commission retained The Lewin Group to identify and analyze recent trends in expenditures and enrollment in New York’s Medicaid program. Analyses were conducted based on New York State data and interviews with New York State officials, and comparisons were conducted using national data sources.
Expertise Area: Medicaid and CHIP
June 2010
Missouri Department of Social Services
This report, prepared under contract to the Missoui Department of Social Services, MO HealthNet Division, focuses on organizational recommendations, as well as recommendations to improve MO HealthNet Program Integrity operations related to cost avoidance and recoveries. The report also provides recommendations to continue developing a collaborative relationship with Medicaid Fraud Control Unit (MFCU), best practices from other states, and Lewin's perspective on creating a new Office of Medicaid Program Integrity.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP, Program Integrity
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