The survey of Medicaid directors in states and the District of Columbia explored current policies or planned changes for the current fiscal year.
Kaiser Family Foundation’s (KFF) 21st annual survey found states’ continued efforts to adopt policies in response to the COVID-19 pandemic has in turn helped to address social determinants of health (SDoH) and health equity issues.
“The pandemic has profoundly affected Medicaid program spending, enrollment, and policy, challenging state Medicaid agencies, providers, and enrollees in a myriad of ways, the survey shows,” wrote KFF researchers.
Survey responses showed more states were implementing or planning provider rate increases, and the majority cited COVID-19 as the reason for payment changes, with the most common rate increases for nursing facilities and community-based services. More than half of the states surveyed also said the pandemic prompted them to expand programs to address SDoH, particularly housing issues. Three-quarters of responding states reported efforts in progress or planned to address racial and ethnic health disparities, particularly maternal and infant health, behavioral health, and COVID-19 related outcomes and vaccinations.
Other key survey findings include:
- Twenty-two states reported new or enhanced benefits in FY 2021, and 29 states plan to add or enhance benefits in FY 22. The most common focuses include expanding behavioral health services, care for pregnant and postpartum women, dental benefits, and housing support.
- Most states cited the value of telehealth to maintain or expand access to care throughout the pandemic, and most states are evaluating post-pandemic telehealth coverage and reimbursement policies.
- Most states that contract with managed care organizations (MCOs) reported that 75 percent or more of their Medicaid beneficiaries were enrolled in MCOs as of July 1, 2021. Children and adults were found to be much more likely to be enrolled than elderly individuals with disabilities.
- Two-thirds of the states that include Medicaid pharmacy benefits in managed care contracts reported prohibiting spread pricing in MCO subcontracts with their pharmacy benefit managers.
In a companion survey report on Medicaid enrollment and spending trends for state fiscal years 2021 and 2022, KFF researchers also found that states expect:
- Medicaid enrollment growth to slow to 4.5 percent in FY 2022, down from 10.3 percent in FY 2021
- Total federal and state Medicaid spending to increase by 7.3 percent, down from 11.4 percent in FY 2021
- State Medicaid spending to grow by 14 percent, an increase from 4 percent in FY 2021
States are likely to face pressures to limit state spending related to enrollment as short-term federal financial support due to the pandemic eventually ends, said KFF researchers.