The year 2020 is almost over, and it is safe to say, there is a collective desire to put this year behind us. As we look to the future, what can we anticipate for Medicaid programs? Here are some trends to keep an eye on.
Enrollment Increases
The Affordable Care Act began allowing for voluntary Medicaid expansion to low-income adults in 2014. Since that time, 39 states (including the District of Columbia) have expanded the program.
The expansion resulted in increases in enrollment until 2018, when enrollment rates began to decline. The decline in enrollment slowed in the beginning of 2020, but then, because of the pandemic, quickly reversed course.
The Kaiser Family Foundation (KFF) reports, between February 2020 and July 2020, enrollment increased by 4.3 million, or 6.1%. As the US continues to grapple with the pandemic and the economic impact, that trend may continue.
Continued Reliance on Medicaid Managed Care
Transition to Medicaid Managed Care is expected to continue. According to the KFF:
· Nationally, 69% of Medicaid beneficiaries are enrolled in a managed care plan.
· 40 states, including the District of Columbia, contract with managed care plans to deliver care.
· In FY 2019, payments to managed care accounted for about 46% of Medicaid spending.
The reach of managed care has the potential to grow as more states consider Medicaid expansion and states trend toward carving in services like behavioral health, pharmacy, dental, and long-term services, and support.
Demographic Changes
Long thought of as a program focused on women and children, the face of Medicaid is changing.
· According to CMS reports, adults account for approximately 20% of new enrollments.
· The elderly are projected to be the fastest-growing segment of the Medicaid population.
Focus on Social Determinants of Health
The Centers for Disease Control and Prevention defines the Social Determinants of Health as the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
KFF reports 35 states to require managed care organizations to use strategies to address at least one of the social determinants of health. These requirements include:
· Screening enrollees for social needs.
· Providing referrals to social services.
· Partnering with community-based organizations.
· Employing community health workers.
We can predict that the emphasis on these areas will continue.
Advancements in Care Delivery
The pandemic quickly shifted how care is delivered, pushing the advancement of both digital solutions and telehealth.
Digital
The health care industry has lagged other industries in its adoption of digital solutions and behind consumer demand. The Electronic Medical Record Adoption model found adoption rates of electronic medical records to be only about 35% in the United States. However, the McKinsey 2017 Consumer Health Insights Survey reported that 70% of consumers wanted digital solutions.
Telehealth
The increase in telehealth utilization has been widely reported, but the statistics continue to be impressive. TriHealth has seen an increase of 3,650% in telehealth utilization over the last six months. Telehealth is one of the biggest trends coming out of 2020 that will likely have an impact in the future.