Recent data released by the Kaiser Family Foundation (KFF) points to continued Medicaid payer market expansion. There also is the potential for the increase in enrollment of the Federal Marketplace plans or Exchange plans with premium tax credits in the non-expansion states.
By 2021, if the 14 states that have not expanded Medicaid under the Affordable Care Act do expand, then 4.7 million uninsured adults could become eligible for Medicaid.
Even before the pandemic, Missouri, Oklahoma, as well as North Carolina and Kansas were considering the benefits of Medicaid expansion. The benefits of Medicaid expansion include:
- Medicaid benefits are more comprehensive compared to marketplace coverage.
- The federal government would pay 90 percent of the bill although there are additional state expenditures that would be needed.
- It would alleviate the worries of the almost 1.9 million who may lose health insurance due to job loss during the pandemic. Eight states (California, Texas, Pennsylvania, New York, Georgia, Florida, Michigan, and Ohio) account for just under half (49%) of all people who lose employer sponsored insurance (ESI).
- Five of the top 8 states for pandemic-related job loss have expanded Medicaid. People eligible for Medicaid among the potentially newly uninsured as of May 2020 in these 5 states account for 40% of all people in that group nationally.
- In the states that have not adopted Medicaid expansion including Texas, Florida, Georgia, and North Carolina, the people who lost their ESI but their income is above Medicaid eligibility but below the poverty level would fall into a coverage gap and could become eligible for Marketplace coverage with premium tax credits. If these non-expansion states expand Medicaid, those who lose their ESI would be eligible for the more comprehensive Medicaid benefits.
#LookingAheadoftheCurve: What is the importance of these trends to the #medtech industry?
Access to health insurance after loss of employment protects people from the devastation of expensive healthcare costs. Our review of the recent KFF analysis shows that:
- Medicaid programs likely will expand in non-expansion states to respond to the need for health coverage because of many losing their employment and employer sponsored health insurance (ESI).
- In the states that have not adopted Medicaid expansion including Texas, Florida, Georgia, and North Carolina, the people who lose their ESI and who meet eligibility criteria could enrol in Marketplace coverage with premium tax credits. These impending changes will likely improve patient access to health care and lifesaving technologies in these markets.
- The improved patient access will expand the Medicaid payer markets for drugs, medical devices, biologics, and diagnostics.
- These Medicaid coverage changes will likely change the payer mix for drugs, medical devices, biologics, and diagnostics.
Why Partner with GIRS?
As more of their clients become Medicaid recipients and as Marketplace enrollment grows, GIRS is #LookingAheadoftheCurve by educating clients about the potential impact on their payer mix and redefining payer market access strategies to secure Medicaid coverage and preferred status for their products.
We currently are working with all Medicaid Fee-for-Service programs educating them about the clinical and cost data for our client’s Products and assisting with the appropriate pricing of these Products. We also are working with Medicaid Managed care and ACA plans to advocate for coverage and appropriate payment.
The GIRS Payer Advocacy Compass PAC® team has over 17 years of experience tracking payer market trends and policies and educating providers and stakeholders about changes to ensure coverage and reimbursement of our clients’ medical technologies.
Please contact us by email or avail or avail of our Complimentary Review of your reimbursement needs at girsinc.com
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About GIRS
For more than 17 years, GIRS has been assisting medical technology manufacturers with their market uptake and reimbursement strategies so that patients can have access to the care that they need. To implement successful market access strategies, the GIRS Value Discovery Landscape Assessments® team and the Payer Advocacy Compass® team work together to develop and implement foundation reimbursement landscape and payer advocacy strategies to obtain positive coverage, appropriate payment, and innovative payer contracting arrangements to improve market uptake. For more information, email us at info@girsinc.com or call us at 901-834-9119.