Hospitals in pursuit of excellence

The Role of Medicaid for Adults with Chronic Illnesses

Medicaid is the nation's health coverage program for the low-income population, covering , more than 60 million people or one in five Americans.It is a diverse group: low-income partents, children and pregnant women, low-income Medicare beneficiaries and people with disabilities.

Beginning in 2014, the Affordable Care Act enables states to expand Medicaid to nearly all people with income at or below 138 percent of the federal poverty level.

This expansion would extend coverage to millions of currently uninsured adults, particularly non-elderly adults without dependent children who have typically been excluded from the program. Since this newly eligible group is largely uninsured and faces limited access to the health care system as a result, they may have substantial unmet need for health care services.

Understanding the current and future role of Medicaid for adults with chronic illnesses can aid policymakers in designing programs to efficiently and effectively meet the needs of enrollees. Specifically, decisions related to benefit design, delivery systems and provider networks may be better informed with information on Medicaid's current role for individuals with chronic illnesses, how well the program serves these individuals, and how the health needs of the newly-eligible compare to those already enrolled.

This brief summarizes a series of policy briefs that examine Medicaid's role for adults with chronic illnesses including diabetes, cardiovascular disease, respiratory disease and mental illness. It compares low-income adults with Medicaid coverage to low-income adults who are uninsured with respect to health needs, health care spending, access to care and utilization of services.

The information provides a profile of Medicaid’s role in supporting population health and how this role could change through the expansion of eligibility in 2014.