Manatt Health Case Study | Manatt, Phelps & Phillips, LLP

Manatt Health Case Study

July 25, 2022

Medicaid Expansion Case Study

Case Background:

– In November 2018, voters in three states—Idaho, Nebraska, and Utah—passed ballot initiatives to expand Medicaid

eligibility levels to 138% of the federal poverty level, as permitted by the Affordable Care Act. Inspired by these

examples, advocates in New Healthland, a state that has not yet expanded Medicaid, have gathered enough

signatures to put a similar initiative to expand Medicaid on the statewide ballot in November 2019.

– New Healthland’s current governor will not be seeking re-election in 2019, and Mary Smith, a moderate

gubernatorial candidate, is developing her position on the Medicaid expansion ballot initiative. She has approached

Manatt Health to develop a policy memorandum to describe her options and inform her position.

Case question:

– Based on what you know about Medicaid expansion, please describe how you would approach this project.

– How would you structure the policy memorandum? What topics would you cover?

– How would you structure the analytic framework? What information or data would you find most helpful to have

when crafting this paper?

– What factors should the candidate most closely consider when forming her position?

Note: This is hypothetical and not based on Manatt clients or work.

Manatt Health Case Study | Manatt, Phelps & Phillips, LLP

Medicaid Expansion Case Study

Case Background:

– In November 2018, three states passed ballot initiatives to expand Medicaid

– Advocates in New Healthland inspired to do the same

– Initiative will expand Medicaid on the statewide ballot in November 2019

– Gubernatorial candidate Mary Smith is developing her position

Mary Smith has approached Manatt Health to:

– develop a policy memorandum

– describe her options

– inform her position

Note: This is hypothetical and not based on Manatt clients or work.

Manatt Health Case Study | Manatt, Phelps & Phillips, LLP

Medicaid Expansion Case Study

Case Background:

– Policy memorandum structure

– Relevant topics

– Analytic framework

– Helpful information or data

– Factors to consider

Note: This is hypothetical and not based on Manatt clients or work.

Manatt Health Case Study | Manatt, Phelps & Phillips, LLP

Issue Tree

Manatt Health Case Study | Manatt, Phelps & Phillips, LLP

Central Question Areas to Explore Additional Details

What are the key

considerations for

expanding Medicaid?

Issue Tree

Manatt Health Case Study | Manatt, Phelps & Phillips, LLP

Central Question Areas to Explore Additional Details

What are the key

considerations for

expanding Medicaid?

A. Impact of expansion  Currently uninsured that would be eligible for Medicaid

with expansion

 Examples/data from other states on improved health

comes

Issue Tree

Manatt Health Case Study | Manatt, Phelps & Phillips, LLP

Central Question Areas to Explore Additional Details

What are the key

considerations for

expanding Medicaid?

A. Impact of expansion  Currently uninsured that would be eligible for Medicaid with expansion

 Examples/data from other states on improved health comes

B. Financial considerations  Benefits —brings money into the state, Federal funding at

90% match rate

 Disadvantage—increased state costs, where will state share

come from?

 Impact to other providers and other stakeholders

(hospitals, FQHCs)

Issue Tree

Manatt Health Case Study | Manatt, Phelps & Phillips, LLP

Central Question Areas to Explore Additional Details

What are the key

considerations for

expanding Medicaid?

A. Impact of expansion  Currently uninsured that would be eligible for Medicaid with expansion

 Examples/data from other states on improved health comes

B. Financial considerations  Benefits —brings money into the state, Federal funding at 90% match rate

 Disadvantage—increased state costs, where will state share come from?

 Impact to other providers and other stakeholders (hospitals, FQHCs)

C. Political considerations  General political environment in the state

 Does the legislature support or oppose expansion?

 Is the legislature suggesting any compromises to pass

expansion e.g., work requirements, premiums, lock-out

periods, or health savings accounts

 How does COVID impact expansion likelihood?

Issue Tree

Manatt Health Case Study | Manatt, Phelps & Phillips, LLP

Central Question Areas to Explore Additional Details

What are the key

considerations for

expanding Medicaid?

A. Impact of expansion  Currently uninsured that would be eligible for Medicaid with expansion

 Examples/data from other states on improved health comes

B. Financial considerations  Benefits —brings money into the state, Federal funding at 90% match rate

 Disadvantage—increased state costs, where will state share come from?

 Impact to other providers and other stakeholders (hospitals, FQHCs)

C. Political considerations  General political environment in the state

 Does the legislature support or oppose expansion?

 Is the legislature suggesting any compromises to pass expansion e.g., work

requirements, premiums, lock-out periods, or health savings accounts

 How does COVID impact expansion likelihood?

D. Timeline / Process  What is the projected timeline for expansion to take effect?

 What activities need to take place to implement

successfully? (legislative approval/budget authority;

Medicaid policy such as 1115 waiver, Medicaid State Plan

Amendment; program design)

Issue Tree

Manatt Health Case Study | Manatt, Phelps & Phillips, LLP

Central Question Areas to Explore Additional Details

What are the key

considerations for

expanding Medicaid?

A. Impact of expansion  Currently uninsured that would be eligible for Medicaid with expansion

 Examples/data from other states on improved health comes

B. Financial considerations  Benefits —brings money into the state, Federal funding at 90% match rate

 Disadvantage—increased state costs, where will state share come from?

 Impact to other providers and other stakeholders (hospitals, FQHCs)

C. Political considerations  General political environment in the state

 Does the legislature support or oppose expansion?

 Is the legislature suggesting any compromises to pass expansion e.g., work

requirements, premiums, lock-out periods, or health savings accounts

 How does COVID impact expansion likelihood?

D. Timeline / Process  What is the projected timeline for expansion to take effect?

 What activities need to take place to implement successfully? (legislative

approval/budget authority; Medicaid policy such as 1115 waiver, Medicaid

State Plan Amendment; program design)

Completed Issue Tree

Manatt Health Case Study | Manatt, Phelps & Phillips, LLP

Central Question Areas to Explore Additional Details

What are the key

considerations for

expanding Medicaid?

A. Impact of expansion  Currently uninsured that would be eligible for Medicaid with expansion

 Examples/data from other states on improved health comes

B. Financial considerations  Benefits —brings money into the state, Federal funding at 90% match rate

 Disadvantage—increased state costs, where will state share come from?

 Impact to other providers and other stakeholders (hospitals, FQHCs)

C. Political considerations  General political environment in the state

 Does the legislature support or oppose expansion?

 Is the legislature suggesting any compromises to pass expansion e.g., work

requirements, premiums, lock-out periods, or health savings accounts

 How does COVID impact expansion likelihood?

D. Timeline / Process  What is the projected timeline for expansion to take effect?

 What activities need to take place to implement successfully? (legislative

approval/budget authority; Medicaid policy such as 1115 waiver, Medicaid

State Plan Amendment; program design)