State Medicaid Programs and Pathways to Health

Audrey McClurg, Noelle Serino, & Sara Villanueva

IMI’s most downloaded resource on the website is its Medicaid state fact sheets, offering comprehensive information on topics such as eligibility, waivers, programmatic offerings, and covered benefits for each state in the U.S., D.C., and Puerto Rico. The Medicaid state fact sheets are designed to provide an overview of the most important aspects of each state’s program, as well as to allow for comparison between states. In response to COVID-19, the fact sheets now include information on Section 1135 waivers, outlining how states have altered the provision of services for Medicaid enrollees to account for the barriers posed by the pandemic. Given the complexity and continuous evolution of the state Medicaid programs, updating the state fact sheets is critical to keeping stakeholders informed of the developments and offerings of each state’s Medicaid program. 

The state fact sheets offer a unique opportunity to identify the variation between each states’ Medicaid program and the ways in which they serve their enrollees. While the general framework and structure of the Medicaid program is the same throughout each state, the nuances of each program vary greatly. States such as New York, Rhode Island, and Oregon have expanded access to services that address social determinants of health. In doing so, Medicaid plans have established requirements for health plans to develop relationships with entities that provide non-medical services and implement programs that are responsive to the social needs of their members. Furthermore, as of August 2020, 44 states have altered the submission deadline for COVID-19 state plan amendments, 13 states have extended reassessment and/or monitoring due dates for home and community-based services, and one state (New York) extended the timeframe to submit internal health plan appeals.

Considerable variation also exists in how states provide services to certain populations including children and those receiving long-term services and supports (LTSS).  While all states cover basic medical services for children, both the income eligibility and the range of programs for children and adolescents differ by state. For example, some states cover school-based health services. Managed long-term services and supports also differ greatly between states, both in how services are provided, and which services are covered. Some states carve-in LTSS with managed care, while others provide LTSS only through traditional fee-for-service arrangements. How care is coordinated and covered is important for long-term management of complex health issues and accessibility of services for enrollees. You can learn more by reading IMI’s reports on LTSS and managed LTSS.  In addition to the variation in the number of services provided for the aforementioned populations, the components of these programs vary greatly. In particular, Minnesota is unique in that it provides coverage for current and former foster youth in transitioning to adulthood. Through the Minnesota Safe Harbor for Youth Program, victims of sexual exploitation are provided coverage for emergency shelter and other medically-related support services. More information on the unique offerings of the state Medicaid programs and other variations can be found by exploring our Medicaid state fact sheets. 

Minnesota Department of Human Services. (2020, March 30). Programs and services. Retrieved from https://mn.gov/dhs/people-we-serve/children-and-families/services/adolescent-services/programs-services/