More About January Angeles

January Angeles

January Angeles is a Policy Analyst at the Center on Budget and Policy Priorities, focusing on Medicaid and state health policy issues.

Full bio and recent public appearances | Research archive at CBPP.org


Restoring Medicaid Payment Bump Would Improve Access to Care

February 3, 2015 at 2:21 pm

The President’s 2016 budget would reinstate health reform’s temporary boost in Medicaid payments for primary care services and extend it to more providers.  It’s a sound proposal, as new evidence shows the rate increase accomplished its goal of improving access to health care by encouraging providers to accept new Medicaid patients.

Medicaid enrollment has risen significantly since health reform’s coverage expansions took effect in January 2014.  Enrollment now tops 69 million — an increase of more than 10 million since October 2013, according to the Centers for Medicare & Medicaid Services.  To help ensure that both current and newly eligible Medicaid beneficiaries had access to care, health reform required states to boost Medicaid payment rates for certain primary care services to Medicare levels in 2013 and 2014, with the federal government picking up 100 percent of the added cost.

The rate increase worked.  A study recently published in the New England Journal of Medicine looked at appointment availability for new patients among primary care physician offices that participate in Medicaid in ten states.  The authors found that it was easier to obtain an appointment after the higher reimbursements took effect.  They also found that states with the largest increases in reimbursements tended to have the largest increases in appointment availability.

The President’s budget would reinstate the rate bump (which expired at the end of 2014) through 2016 and extend it to more practitioners who provide primary care services, including obstetricians, gynecologists, physician’s assistants, and nurse practitioners.  With more people than ever enrolled in Medicaid and the need for cost-effective Medicaid primary care rising across the country, the higher payment rates would help ensure that primary care providers now participating in Medicaid continue to do so.

Auto-Renewal Not the Best Option for Enrollees in Federal Insurance Marketplace

November 21, 2014 at 2:08 pm

People who bought private health insurance last year through the federally run marketplace could pay more than they should next year unless they return to the marketplace to renew coverage, our new paper explains.

That’s because they will be automatically re-enrolled in the same plan in 2015, with the same subsidies to help pay for coverage, unless they choose a plan through the marketplace during the open enrollment season, which began November 15.

The federal marketplace, which operates in the 34 states that don’t have a state-based marketplace (see map), provides auto-renewal as a backstop to ensure that people who don’t return to the marketplace don’t lose coverage.  But auto-renewal won’t account for factors that affect the level of people’s subsidies and can change from year to year, such as a household’s size or income and premiums for health coverage.  As a result, many people who auto-renew will receive subsidies that don’t reflect what they’re eligible for.

The only way for consumers to ensure they receive the correct level of benefits is to provide updated information to the marketplace and have their eligibility re-determined.

New Study Shows Link Between Medicaid Coverage of Prenatal and Infant Care and Better Long-Term Health Outcomes

September 4, 2014 at 10:12 am

The benefits of good prenatal and infant care for a child’s development are well documented, so it makes sense that improving access to care by expanding Medicaid coverage to pregnant women and children would produce long-term gains.  A new study suggests that as well.

University of Michigan researchers examined the health in young adulthood of people born during the 1980s and early 1990s, when states significantly expanded Medicaid to cover more low-income pregnant women and children in response to new federal requirements and added state flexibility.  Building on a large body of research documenting the benefits of Medicaid, they found that people who were more likely to be eligible for Medicaid during their prenatal and infant stages had better health and fewer preventable hospitalizations as young adults than those who were less likely to be eligible for Medicaid.

Specifically, a ten-percentage-point increase in the share of women of childbearing age who were eligible for Medicaid was linked to the following positive outcomes for young adults (ages 19-33) born during the expansion:

  • lower body mass index and a 7 percent drop in the likelihood of obesity;
  • a nearly 2 percent decline in preventable hospitalizations overall and a 9 to 10 percent decline in preventable hospitalizations related to chronic conditions; and
  • an 8 to 10 percent drop in hospitalizations related to conditions that benefit from regular medical evaluations in early childhood, such as diabetes.

As noted, other studies have shown the health benefits of expanding Medicaid, but this study shows the link between Medicaid coverage and positive long-term health outcomes as well.  It’s one more reason why states that haven’t yet adopted health reform’s Medicaid expansion should get off the sidelines.

The Tax Rules That Health Care Assisters Need to Know

July 31, 2014 at 4:39 pm

“Navigators” and others helping people apply for health coverage need to understand basic tax filing rules because eligibility for Medicaid, the Children’s Health Insurance Program (CHIP), and premium tax credits for coverage bought through federal and state Marketplaces is based on Internal Revenue Code definitions of income and household.  We’ve developed The Health Care Assister’s Guide to Tax Rules to help fill this need.

The guide provides basic information on relevant tax rules, including when someone is required to file taxes, what filing status options are available, the rules for claiming someone as a tax dependent, and what sources of income are taxable and therefore counted in determining eligibility for Medicaid, CHIP, and premium tax credits.  It also shows how Medicaid uses an individual’s tax filing status to determine who is in his or her household, and how Medicaid’s household rules differ from those used for premium tax credits.

Understanding these issues can help health care assisters work with applicants for health coverage, especially those who have complicated family situations or unpredictable sources of income or are not familiar with filing taxes.

President’s Budget Reaffirms Federal Commitment to Pay for Nearly All of Medicaid Expansion

March 13, 2014 at 11:15 am

As policymakers in a number of states debate whether to adopt health reform’s Medicaid expansion, opponents continue to claim that the federal government, in the name of deficit reduction, will inevitably renege on its commitment to fund nearly all of the cost and instead shift large costs to states.  As Florida state senator Jeff Brandes put it recently, “Why in the world would we take the federal government’s . . . promise that they’ll pay for [the] Medicaid expansion when we know that they will be unable to keep that promise in the long run?”

But, there’s no evidence to support that argument, as we’ve pointed out (see here and here).

The Obama Administration has repeatedly said that it will oppose any cost-shifts that would make states less likely to take up the Medicaid expansion.  And, the President’s new budget reaffirms yet again that the federal government will pick up nearly all of the expansion’s costs:  100 percent for the first three years (2014-2016) and no less than 90 percent on a permanent basis.

Like last year’s budget, the President’s budget has no Medicaid proposals that produce federal savings by shifting costs to states.  It instead proposes to achieve some Medicaid savings by lowering the program’s prescription drug costs.

Moreover, as we’ve pointed out, pressures to cut Medicaid and shift costs to states in order to reduce the federal deficit have dissipated.  In fact, the only federal lawmakers now pushing to shift Medicaid costs to states are not health reform proponents but instead those who oppose health reform and who would convert Medicaid to a block grant or set a per capita cap on federal Medicaid funding.