States' Implementation of the Patient Protection and Affordable Care Act

U.S. Government Accountability Office

 

To learn more about completing the questionnaire, printing your responses, and who to contact if you have questions, click here for help.

(View responses)
 

Medicaid Expansion

  The following questions ask for your best judgments, based on current information, of the implications of Medicaid expansion implementation. Briefly, PPACA requires states to expand Medicaid coverage to:

•Individuals who were previously ineligible (primarily childless adults) will be covered up to 133 percent of the federal poverty level (FPL) beginning in 2014 with eligibility based on modified gross income (MAGI) and no assets or resource tests.

•Newly eligible costs: the federal government would be responsible for 100 percent of the cost of the newly eligible through 2016 with the state contribution gradually increasing to 10 percent by 2020.

•Previously covered newly eligible: states that had already covered newly eligible adults up to 100 percent of the FPL in 2010 would see a gradual increase in their federal matching rate for these individuals with the state share capped at 10 percent by 2020.
(View responses)
 

State Budget Cycle

1.  What budget cycle does your state operate on?

Click one button.
(View responses)
 

Costs and Savings From Implementing Medicaid Expansion

2.  To the best of your knowledge, do you think each of the following potential aspects of Medicaid expansion will contribute a net cost or a net savings to your state's budgets from 2012 through 2014, from 2015 through 2017, and from 2018-2020?

For each aspect of Medicaid expansion implementation, click the one button that best characterizes its impact for 2012-2014 taken as a whole, the impact for 2015-2017 taken as a whole, and the impact for 2018-2020 taken as a whole.
(View responses)
 
Net impact on your state's budgets for FY 2012-2014?
Net impact on your state's budgets for FY 2015-2017?
Net impact on your state's budgets for FY 2018-2020?
  Administration for managing Medicaid enrollment
(View responses)
 
(View responses)
 
(View responses)
 
(View responses)
  Acquisition of new information technology or modifications to existing information technology systems to support Medicaid eligibility determinations and enrollment
(View responses)
 
(View responses)
 
(View responses)
 
(View responses)
 
Changes in enrollment levels due to:
Net impact on your state's budgets for FY 2012-2014?
Net impact on your state's budgets for FY 2015-2017?
Net impact on your state's budgets for FY 2018-2020?
  Enrolling previously eligible but not enrolled individuals into Medicaid
(View responses)
 
(View responses)
 
(View responses)
 
(View responses)
  Enrolling newly eligible adults into Medicaid (click here for details)
(View responses)
 
(View responses)
 
(View responses)
 
(View responses)
  Shifting individuals from state-funded coverage into Medicaid
(View responses)
 
(View responses)
 
(View responses)
 
(View responses)
  Shifting existing Medicaid enrollees into health benefit exchanges
(View responses)
 
(View responses)
 
(View responses)
 
(View responses)
  Other enrollment changes - describe in box below table
(View responses)
 
(View responses)
 
(View responses)
 
(View responses)
 
Net impact on your state's budgets for FY 2012-2014?
Net impact on your state's budgets for FY 2015-2017?
Net impact on your state's budgets for FY 2018-2020?
  Reductions in uncompensated care
(View responses)
 
(View responses)
 
(View responses)
 
(View responses)
  Other aspects of Medicaid expansion implementation - describe in box below table
(View responses)
 
(View responses)
 
(View responses)
 
(View responses)
 
  IF OTHER ENROLLMENT CHANGES: What are those changes that will contribute to a net cost or savings to your states' budget(s)?
(View responses)
 
  IF OTHER ASPECTS OF MEDICAID EXPANSION IMPLEMENTATION: What are those other aspects that will contribute to a net cost or savings to your states' budget(s)?
(View responses)
 

Maintenance of Effort

3.  Has your state applied to the Centers for Medicare and Medicaid Services (CMS) for an exemption from the Maintenance of Effort requirement for the period January 1, 2011 through December 31, 2013?
(View responses)
 
4.  IF "YES:" What is the current status of this application?
(View responses)
 
5.  Does your state intend to apply for an exemption from the Maintenance of Effort requirement for the period January 1, 2011 through December 31, 2013?
(View responses)
 

Enrollment Rates

6.  What does your state estimate the enrollment rate will be for the newly eligible Medicaid population in each of the following time periods?
Click one button in each row.
(View responses)
   
0 - 24%
25 - 49%
50 - 74%
75 - 99%
100%
Don't know
  Fiscal year 2014
(View responses)
  Fiscal years 2015-2017
(View responses)
  Fiscal years 2018-2020
(View responses)
 

State Budget Development

7.  Has your state developed any planning documents that include milestones and/or steps to address the expansion of Medicaid eligibility and the transition to a new eligibility determination system in your state's budget? Planning documents could include, but are not limited to, work plans, timelines, process charts, memos, etc.
(View responses)
 
8.  Now consider the possible uncertainties that could affect the implementation of Medicaid expansion in your state. Does your state budget development process include a risk assessment or gap analysis to address possible uncertainties that could affect implementation of Medicaid expansion in your state?
(View responses)
 
 

(View responses)
 

IF YES: Please briefly describe those uncertainties and the assessment or analyses conducted:

(View responses)
 
9.  Does your state budget development process include or consider various implementation scenarios?
(View responses)
 

Implementation Challenges and Opportunities

10.  From a state budget perspective, what are the biggest challenges that impact budget estimates for implementing PPACA Medicaid expansion provisions? Describe up to three challenges in the spaces below. The box will scroll to accommodate your typed answer as needed.
(View responses)
 
 

1st challenge:
(View responses)
 

(View responses)
 

2nd challenge:
(View responses)
 

(View responses)
 

3rd challenge:
(View responses)
 

(View responses)
 
11.  What strategies, if any, is your state using to address any of the challenges you described in the previous question?
(View responses)
 
 

Strategy for 1st challenge:
(View responses)
 

(View responses)
 

Strategy for 2nd challenge:
(View responses)
 

(View responses)
 

Strategy for 3rd challenge:
(View responses)
 

(View responses)
 
12.  How challenging, if at all, is each of the following factors to the implementation of PPACA's Medicaid expansion provisions?
(View responses)
   
Very challenging
Moderately challenging
Slightly challenging
Not at all challenging
Don't know / Not applicable
  State fiscal capacity
(View responses)
  State share of the states' Medicaid expenditures
(View responses)
  Local or county share of the states' Medicaid expenditures
(View responses)
  Federal funding for Medicaid expansion implementation (2017-2020)
(View responses)
  Other factor(s) - describe in box below table
(View responses)
 
  IF OTHER FACTOR(S):
(View responses)
 
13.  What opportunities, if any, does Medicaid expansion present for your state?
(View responses)
 
14.  To what extent, if at all, was any guidance your state received from CMS clear, complete, and received in a timely manner for the development of budget estimates for Medicaid expansion? Select the answer that best characterizes guidance you may have received, regardless of whether your state has yet developed budget estimates for Medicaid expansion.
(View responses)
   
Great extent
Moderate extent
Some extent
Little or no extent
Don't know / Not applicable
  Clarity of guidance
(View responses)
  Completeness of guidance
(View responses)
  Timeliness of guidance
(View responses)
 
15.  Overall, how useful or not useful has the CMS guidance been for the development of budget estimates for Medicaid expansion?
(View responses)
 
16.  What additional information or guidance, if any, does your state need from CMS or other federal agencies to assist with developing budget estimates for implementing PPACA's Medicaid expansion provisions?
(View responses)
 

Comments on Your Medicaid Expansion Answers

17.  Do you have any explanations of or comments on any of your answers regarding the budgetary implications of the implementation of Medicaid expansion? Are there any issues we have not addressed that you believe we should consider?
(View responses)
 
 

In addition to Medicaid expansion, the survey also asked questions about health exchanges and their impact on states' budget planning efforts (which we had included as questions 18-32). Because our report focuses only on Medicaid expansion, we include only the responses to the questions about Medicaid expansion. GAO plans to report on health exchanges next year.

Contact Information

33.  Who is the person primarily responsible for completing this questionnaire whom we can contact in case we need to clarify a response?
(View responses)
  Contact name:
(View responses) 		 
  Title:
(View responses) 		 
  Email address:
(View responses) 		 
  Telephone number:
(View responses) 		 
 
34.  Are you done with this questionnaire?
Clicking "Yes" below tells GAO that your answers are final. We will not use your answers unless the "Yes" button is checked when you last exit the questionnaire.
(View responses)
 
35.  Would you like a record of your answers to this questionnaire? If so, click here to view and print a summary of your responses.

Click on the Save & Exit Questionnaire button below to exit the survey.

Thank you for completing this questionnaire!
(View responses)



Please wait, file upload in progress.