State Alternatives to Medicaid Expansion

States are being encouraged to take the federal money and run — headlong into expanding their Medicaid program. However, this federal gravy train cannot go on forever. In a paper commissioned by the Galen Institute, Chris Jacobs explains that states have other options when reforming health care within their states:

  • Rhode Island got a waiver granting it the flexibility to use home and community-based services as an alternative to nursing homes.
  • Indiana developed a program similar to consumer-driven health plans to provide coverage and the appropriate incentives to low-income populations.
  • Florida successfully tested private managed care plans as a way to cover low-income families.

Lessons from other states are also evident from the early-stage experiments. According to Chris Jacobs, these follow a common theme:

  • Customized Beneficiary Services.
  • Coordinated and Preventive Care.
  • Personal Responsibility.
  • Home and Community-Based Services.
  • No New Federal Funds.

Comments (13)

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  1. Saket says:

    I agree, having a bottom-up approach that allows people to experiment and be innovative is the best way to solve the health care dilemma.

  2. Patel says:

    Well, I am glad to see the passage of ACA is encouraging states to come up with different ways to provide health care to their population.

  3. Desai says:

    Is Texas coming up with something unique, because the last time I checked, Texas is one of the state that is resisting the Obama Health Exchange.

  4. Sandeep says:

    I think Rhode Island’s way seems to be an effective way for cost containment for the aging population. That way they have a better quality of life as oppose to being stuck in nursing homes.

  5. Kumar says:

    This just might mean that private sectors now have to finally start working to get their price in check now that they have competition. This is not bad.

  6. Espy says:

    Personal Responsibility? What are we, republicans?

  7. Harley says:

    I’ma call the grammar Nazi’s on you, Espy.

    This mildly resembles the vague republican plan for decentralized health systems. Given the negative correlation with health/growth in various states, that would probably be a good thing.

  8. A.D. Samson says:

    Personal Responsibility is way underated in most policies.

  9. Devon Herrick says:

    Something many states are considering is applying for selective waivers for those earning less than 100% of poverty. This would free those earning above 100% to get subsidized private coverage in the Exchanges.

  10. Johanne says:

    When one possibility does not seem efficient, in this case the health reform, you’ve got to try something else. Even if states are only doing this within their own regions, there’s still a big chance that the impact they will have on neighbor states is better than that of the health reform. It’s good to see that regardless of government regulations, states are taking matters into their own hands and coming up with better approaches to this situation. Props to the Galen Institute for a very informative paper!

  11. Anthony S says:

    Hopefully in the future the federal government will be able to see which states have adopted alternative implementations and end up overhauling the system based on a possible general trend working for several states.

  12. Eden says:

    It’ll be interesting to see which states adopt different practices through waivers and exceptions.

  13. Gabriel Odom says:

    Personal responsibility? I don’t need that – I have Mayor Bloomberg to tell me what’s good for me.