More About Judy Solomon

Judy Solomon

Solomon is Vice President for Health Policy at the Center on Budget and Policy Priorities, where she focuses on Medicaid and the Children’s Health Insurance Program and issues related to the implementation of health reform, particularly policies to make coverage available and affordable for low-income people.

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


Lower Recidivism: Yet Another Good Reason for States to Expand Medicaid

June 25, 2014 at 2:54 pm

Some opponents of health reform’s Medicaid expansion have cited an estimate that 35 percent of adults newly eligible for Medicaid have been involved in the criminal justice system in the past year.  This figure is highly inflated.

In reality, only about 17 percent of newly eligible adults who enroll in Medicaid will have been in jail or prison.  But even though they will make up about one-sixth rather than one-third of new Medicaid enrollees, their number is significant — and connecting these low-income adults to the health care system can help them avoid returning to jail or prison, as we explain in a new paper.

On any given day, about 750,000 people are in jail; about 75 percent of them for nonviolent offenses.  As many as 90 percent of people in jail are uninsured.  This figure isn’t surprising; until health reform’s coverage expansions took effect this year, there was no pathway to health coverage for poor and low-income adults who weren’t parents living with their minor children, pregnant women, seniors, or people with disabilities.  Not many people with prison or jail stays fall into these categories.

Health reform opened up Medicaid eligibility for all adults with incomes below 138 percent of the poverty line.  So far, 26 states and the District of Columbia have decided to expand coverage.  In addition, adults who aren’t eligible for Medicaid or employer coverage and have incomes between 100 and 400 percent of the poverty line can qualify for premium tax credits to help them afford private coverage through the new health insurance marketplaces.  Roughly half of people leaving jail can qualify for coverage through Medicaid or the marketplaces.  (This figure takes into account that about half of the states have adopted the Medicaid expansion and half have not.)

A number of states and counties are working to connect people released from jail to health coverage for the first time, with a particular focus on people with mental illness and substance-use disorders, given the prevalence of these conditions in this population and the role of these conditions in increasing criminal activity.

States considering whether to expand Medicaid should consider the growing evidence that connecting the jail-involved population to treatment for mental illness and substance abuse can lower the rate at which they return to jail or prison.

For example, a study of a Michigan program to help recently released prisoners obtain community-based health care and social services found that it cut recidivism by more than half, from 46 percent to 21.8 percent.  Similarly, a study that the Justice Department funded in Florida and Washington found that “in both states, 16 percent fewer jail detainees with serious mental illnesses who had Medicaid benefits at the time of their release returned to jail the following year, compared to similar detainees who did not have Medicaid.”

Click here to read the full paper.

Medicaid Primary Care Payment Rate Bump Is Worth Extending

June 19, 2014 at 12:45 pm

An increase in Medicaid primary care payment rates that was included in health reform is scheduled to expire at the end of this year.  But with the need for cost-effective Medicaid primary care rising across the country, the current physician rates should be maintained — and expanded to additional providers — as the Obama Administration and a group of hospitals and doctors have recommended.

Medicaid enrollment has risen by 6 million since October, according to the Centers for Medicare and Medicaid Services, and total enrollment now tops 65 million.  With increased enrollment comes increased need for providers, particularly those providing primary care.  Connecting patients to primary care makes it more likely that they will receive the preventive care and other services to remain healthy and makes it less likely that they will later have to visit the emergency room.

Health reform required states to pay for primary care services at the Medicare rate, which is typically higher than the Medicaid rate, for 2013 and 2014; the federal government picked up 100 percent of the cost of the increase over the state’s regular Medicaid rate for those years.  In boosting physicians’ rates, policymakers intended to increase the number of primary care providers participating in Medicaid in order to ensure access to primary care for Medicaid beneficiaries — both those newly eligible and those who were eligible before 2014.  In Connecticut, the number of primary care providers enrolled in Medicaid has more than doubled since January 2012 and state officials are pushing for an extension of the temporary increase.

Twenty-one organizations representing physicians and hospitals recently wrote to Senate and House leaders to promote a two-year extension of the current payment rate.  The group also asked that policymakers extend the enhanced Medicaid rate to physicians practicing obstetrics and gynecology if their practices provide significant amounts of primary care.  The President’s budget included a one-year extension of the primary care rate increase that would also extend the enhanced rate to include physician assistants and nurse practitioners who provide primary care services.  Both the expansions of the payment increase to additional providers and an extension of the rate increase for at least another year deserve support.

Scare Tactics Shouldn’t Dissuade States From Expanding Medicaid

April 23, 2014 at 2:16 pm

The Foundation for Government Accountability (FGA), a Florida-based conservative think tank, is using scare tactics in its campaign against Medicaid expansion.  It claims that Arkansas taxpayers will have to pay tens of millions of dollars to the federal government in 2014 cost overruns in the state’s “private option” Medicaid expansion.  But that claim doesn’t hold up, and it shouldn’t keep other states from pursuing the private option to expand Medicaid.

The federal government approved Arkansas’ Medicaid expansion through a demonstration project, under which the state will use Medicaid funds to buy private health insurance plans for newly eligible adults through its Marketplace.  The per-person cost of covering these new Medicaid beneficiaries for the first four months of the demonstration project was slightly above projections incorporated in the terms and conditions to which the state agreed with the federal government, prompting FGA’s claim.

Demonstration projects (which are usually called “waivers”), like Arkansas’ private option, must not cost the federal government more than it would have otherwise spent.  If the project is not budget neutral over its entire duration, a state could have to repay excess federal spending.  This is extremely unlikely to happen in Arkansas, for several reasons:

  • Budget neutrality is determined over the entire term of the demonstration project —three years in this case — not what happens in 2014, as FGA claims.  Arkansas would only have to repay the federal government if total three-year spending on the private option exceeds the three-year limit.
  • The terms of the waiver recognize that the budget neutrality limit is a forecast, and like all estimates, it could be off in either direction.  Arkansas can ask for an upward adjustment if the limits underestimate the actual costs of covering the new beneficiaries.  At the same time, the state won’t share in any federal “savings” if costs are lower than projected.
  • Arkansas is taking steps that will likely keep spending within the three-year limit.  In 2014, some health plans offered extra benefits that increased premiums and hence per-beneficiary costs under the waiver.  Starting in 2015, insurers will have to offer plans without these extra benefits to private option participants, which should bring down premiums and per-person costs to stay below the budget neutrality limits.  Other states that pursue the private option model can prevent health plans from offering these more expensive plans to begin with, thus avoiding this problem altogether.

More than 150,000 low-income adults have gained Medicaid coverage in Arkansas in 2014, and enrollment continues to grow.  That’s the lesson that the 24 states that have not expanded — where 4.8 million uninsured adults fall into the coverage gap that results from not taking the Medicaid expansion — should take away from Arkansas.

Haven’t Enrolled in Marketplace Health Coverage? Three Things to Know

April 8, 2014 at 11:31 am

More than 7 million people had signed up for private coverage by the time open enrollment in health reform’s insurance marketplaces ended March 31.  But, what about those who are still trying to enroll — and those who don’t need coverage now but may need it later in the year when their circumstances change?  Here are three basic points on who can sign up between now and November 15, when the next open enrollment period begins:

First, people eligible for Medicaid can sign up any time — unlike private coverage, Medicaid has no limited enrollment period.  Medicaid eligibility varies by state but, in states that chose to expand Medicaid under health reform, people with income up to 138 percent of the poverty line (about $27,000 for a family of three) can enroll.

Second, people who began signing up in the federal marketplace at healthcare.gov by March 31 have until April 15 to finish and enroll in a plan.  And people who experienced problems with healthcare.gov or have other exceptional circumstances can get additional time.  In states with their own marketplaces, the deadlines vary, so check the marketplace website for details.

Third, many people who lose other coverage (such as Medicaid or job-based coverage) or experience other changes can enroll in marketplace coverage during “special enrollment periods” (SEPs).

Most major life changes trigger a SEP:

  • Losing other health coverage;
  • Moving to a different state, or even within a state if the move changes which plans are available;
  • Getting married; and
  • Having a baby or adopting a child.

But some significant life changes don’t trigger a SEP by themselves, such as getting divorced (unless the person getting divorced loses coverage or moves).  Losing a job without losing coverage also doesn’t trigger a SEP.

For more information on special enrollment periods and other health reform topics, check out CBPP’s special project Health Reform:  Beyond the Basics.

Obama Budget Would Improve Access to Health Care for Underserved Populations

March 14, 2014 at 2:07 pm

As health reform enables millions of uninsured Americans to gain health insurance, the need for preventive and primary care services and those who provide them will continue to grow.  The President’s 2015 budget includes a new initiative to strengthen the health workforce — particularly for underserved areas and populations with shortages of providers — and ensure adequate payments for primary care physicians, physician assistants, and nurse practitioners who see Medicaid patients.  It deserves Congress’ approval.

The initiative would:

  • Expand the National Health Service Corps, which boosts the number of health care providers in high-need communities through scholarships and other kinds of support.  The program would receive an extra $4 billion over fiscal years 2015 through 2020, allowing it to support 15,000 providers (up from the current 9,000) delivering care to more than 16 million people.
  • Provide $5.2 billion over ten years for a new competitive grant program for medical residency positions that would encourage primary care physicians to practice in rural and other underserved areas.
  • Continue Medicaid’s enhanced payment rate for primary care services, scheduled to end on December 31, 2014, through December 2015, at a total cost of $5.4 billion.  This provision requires states to pay providers at the Medicare rate; the federal government covers 100 percent of the boost from the state’s regular Medicaid rate. The President’s budget also would extend the enhanced Medicaid rate beyond primary care physicians to include physician assistants and nurse practitioners.