Under Medicaid expansion, individuals under the age of 65 will qualify for Medicaid if they earn up to 138% of the federal poverty level (FPL). Eligibility limits for children and pregnant women are even lower, meaning their household income is allowed to be higher than 138% of FPL, up to 266% on average for children in expansion states. As of May 1, 2024, 10 states have not adopted the Medicaid expansion. In these states, childless adults who are not disabled or pregnant are not eligible for Medicaid no matter their income (except for Wisconsin). Moreover, a parent with two dependent children may only earn up to as little as 34 percent FPL on average to be eligible for Medicaid. The Medicaid income eligibility within non-expansion states varies greatly. This statistic displays the median Medicaid income eligibility limits for children and adults as a percent of the Federal Poverty Level (FPL) as of May 1, 2024, by state expansion status.

U.S. states refusing to expand Medicaid often cite high cost as a reason. However, according to this data, the state of Virginia was able to save up to an estimated 85 percent of expected state expansion costs in 2020, just from savings to traditional Medicaid. This is because the federal matching rate is much higher for Medicaid expansion than traditional Medicaid. States pay roughly 25 to 50 percent of the cost for a traditional Medicaid beneficiary, but only 10 percent of the cost for an expansion beneficiary. Virginia is estimated to save 221.4 million U.S. dollars in FY2020, which amounts to roughly 85 percent of its expected state expansion costs in 2020. While there are large variations between states, expansion states may also see reduced spending outside of Medicaid, such as in the areas of uncompensated care and mental health and substance abuse treatment. By reducing the number of uninsured, states can potentially make savings in these other programs that support the uninsured.

ImportanceThe Affordable Care Act (ACA) has expanded access to health insurance for millions of Americans, but the impact of Medicaid expansion on healthcare delivery and utilization remains uncertain.ObjectiveTo determine the early impact of the Medicaid expansion component of ACA on hospital and ED utilization in California, a state that implemented the Medicaid expansion component of ACA and Florida, a state that did not.DesignAnalyze all ED encounters and hospitalizations in California and Florida from 2009 to 2014 and evaluate trends by payer and diagnostic category. Data were collected from State Inpatient Databases, State Emergency Department Databases and the California Office of Statewide Health Planning and Development.SettingHospital and ED encounters.ParticipantsPopulation-based study of California and Florida state residents.ExposureImplementation of Medicaid expansion component of ACA in California in 2014.Main outcomes or measuresChanges in ED visits and hospitalizations by payer, percentage of patients hospitalized after an ED encounter, top diagnostic categories for ED and hospital encounters.ResultsIn California, Medicaid ED visits increased 33% after Medicaid expansion implementation and self-pay visits decreased by 25% compared with a 5.7% increase in the rate of Medicaid patient ED visits and a 5.1% decrease in rate of self-pay patient visits in Florida. In addition, California experienced a 15.4% increase in Medicaid inpatient stays and a 25% decrease in self pay stays. Trends in the percentage of patients admitted to the hospital from the ED were notable; a 5.4% decrease in hospital admissions originating from the ED in California, and a 2.1% decrease in Florida from 2013 to 2014.Conclusions and relevanceWe observed a significant shift in payer for ED visits and hospitalizations after Medicaid expansion in California without a significant change in top diagnoses or overall rate of these ED visits and hospitalizations. There appears to be a shift in reimbursement burden from patients and hospitals to the government without a dramatic shift in patterns of ED or hospital utilization.

This is a Center for Behavioral Health Statistics and Quality (CBHSQ) short report examining lack of insurance rates among individuals with a behavioral health disorder in states that expanded Medicaid eligibility, did not expand Medicaid eligibility, and are undecided. It uses 2009-2013 data from the National Survey on Drug Use and Health (NSDUH).

U.S. President Joe Biden's COVID-19 relief bill passed in March 2021, also known as the American Rescue Plan (ARP), has effectively removed the Affordable Care Act's subsidy cliff for the years 2021 and 2022. The subsidy cliff refers to the steep drop off of health insurance subsidies for those who earn just slightly above 400% of the Federal Poverty Level. Above this income threshold, which varies depending on household size, an individual will have to pay the full amount for their insurance premium. This statistic shows that for example, the health premium for an individual of 60 years who earns more than 51,040 U.S. dollars (400% FPL) would skyrocket to roughly 20 percent of their income. The subsidy cliff affects older adults the most (and those in states with high premiums) because they have relatively high premiums compared to younger adults. With the ARP, annual Marketplace plan premiums are capped at 8.5 percent of household income and also increase the subsidies of those with low-income, with many plans available at zero U.S. dollars in premium. While the ARP is only effective temporarily for the years 2021 and 2022, some say the legislation is here to stay as benefits are difficult to take away once introduced.

Abstract (en): In January 2013, the Urban Institute launched the Health Reform Monitoring Survey (HRMS), a quarterly survey of the nonelderly population, to explore the value of cutting-edge, Internet-based survey methods to monitor the Affordable Care Act (ACA) before data from federal government surveys are available. Topics covered by the second round of the survey (second quarter 2013) include self-reported health status, type of and satisfaction with current health insurance coverage, access to and use of health care, health care affordability, whether the respondent considered purchasing or tried to purchase health insurance coverage directly from an insurance company, whether the respondent considered obtaining coverage through Medicaid or other government sponsored assistance plan based on income or disability, sources of information about health insurance, and the importance of various criteria in choosing a health insurance plan. Additional information collected by the survey includes age, education, race, Hispanic origin, gender, income, household size, housing type, marital status, employment status, number of employees at place of work, United States citizenship, smoking, internet access, home ownership, body mass index, sexual orientation, and whether the respondent reported an ambulatory care sensitive condition or a mental or behavioral condition. ICPSR data undergo a confidentiality review and are altered when necessary to limit the risk of disclosure. ICPSR also routinely creates ready-to-go data files along with setups in the major statistical software formats as well as standard codebooks to accompany the data. In addition to these procedures, ICPSR performed the following processing steps for this data collection: Checked for undocumented or out-of-range codes.. Response Rates: The HRMS response rate is roughly five percent each quarter. Datasets:DS0: Study-Level FilesDS1: Public-use DataDS2: Restricted-use Data Household population aged 18-64. Each quarterly HRMS sample is drawn from the KnowledgePanel, a probability-based, nationally representative Internet panel maintained by GfK Custom Research. Beginning with the second quarter of 2013, the HRMS includes oversamples of adults with family incomes at or below 138 percent of the federal poverty level and adults from selected state groups based on (1) the potential for gains in insurance coverage in the state under the ACA as estimated by the Urban Institute's microsimulation model and (2) states of specific interest to the HRMS funders. Additional funders have supported oversamples of adults from individual states or subgroups of interest (including children). However, ICPSR received data only for the adults in the general national sample and the income and state group oversamples. 2019-07-10 Variable Q7_F was removed from public dataset. An updated codebook excluding this variable was provided for public use. Current release will feature DS1 as public-use data only and DS2 as restricted-use data. Previous release included both public and restricted versions of DS1. Study title updated to include geographic information.2017-06-20 The principal investigators added a new weight variable to the data file and the technical documentation was updated accordingly.2015-03-23 The principal investigators deleted the multiple imputation variables _1_famsize, _2_famsize, _3_famsize, _4_famsize and _5_famsize. ICPSR revised the codebook accordingly and added to the collection a plain text version of the data with a Stata setup and record layout file. Funding institution(s): Ford Foundation. Urban Institute. Robert Wood Johnson Foundation (71390). web-based survey

California has more Medicaid and CHIP enrollees than any other state in the United States. As of April 2023, approximately ** million Americans were enrolled in the Medicaid health insurance programs in California, which accounted for approximately ** percent of the total number of Medicaid enrollees nationwide (**** million). Blow to Medicaid expansion plans California is one of many states that has expanded its Medicaid program under the Affordable Care Act (ACA) to encourage more low-income adults to sign up for health coverage. One of the original aims of the ACA was to limit some of the variations in state Medicaid programs, but the Supreme Court ruled that the expansion should be optional. Governors of the states that did not expand said they were concerned about long-term costs. California is the leading state for Medicaid expenditure, spending approximately **** billion U.S. dollars in FY2020. Health coverage for children The Children’s Health Insurance Program (CHIP) was created as a complement to Medicaid, expanding the reach of government-funded health coverage to more children in low-income families. As of May 2021, over **** million children were enrolled in Medicaid/CHIP programs in California, more than any other state. As of January 2021, the median Medicaid/CHIP eligibility level for children was *** percent of the federal poverty level.

As of 2024, nearly *** million people in the United States had some kind of health insurance, a significant increase from around *** million insured people in 2010. However, as of 2024, there were still approximately ** million people in the United States without any kind of health insurance. Insurance coverage The United States does not have universal health insurance, and so health care cost is mostly covered through different private and public insurance programs. In 2021, almost ** percent of the insured population of the United States were insured through employers, while **** percent of people were insured through Medicaid, and **** percent of people through Medicare. As of 2022, about *** percent of people were uninsured in the U.S., compared to ** percent in 2010. The Affordable Care Act The Affordable Care Act (ACA) significantly reduced the number of uninsured people in the United States, from **** million uninsured people in 2013 to **** million people in 2015. However, since the repeal of the individual mandate the number of people without health insurance has risen. Healthcare reform in the United States remains an ongoing political issue with public opinion on a Medicare-for-all plan consistently divided.

Drug use treatment and treatment setting among privately insured adults with drug use disorders with and without coverage of drug use treatments in the National Survey on Drug Use and Health, 2005–2018.

Abstract (en): In January 2013, the Urban Institute launched the Health Reform Monitoring Survey (HRMS), a quarterly survey of the nonelderly population, to explore the value of cutting-edge, Internet-based survey methods to monitor the Affordable Care Act (ACA) before data from federal government surveys are available. Topics covered by the first round of the survey (first quarter 2013) include self-reported health status, type of and satisfaction with current health insurance coverage, access to and use of health care, and health care affordability. Additional information collected by the survey includes age, education, race, Hispanic origin, gender, income, household size, housing type, marital status, employment status, United States citizenship, smoking, internet access, home ownership, body mass index, sexual orientation, and whether the respondent reported an ambulatory care sensitive condition or a mental or behavioral condition. ICPSR data undergo a confidentiality review and are altered when necessary to limit the risk of disclosure. ICPSR also routinely creates ready-to-go data files along with setups in the major statistical software formats as well as standard codebooks to accompany the data. In addition to these procedures, ICPSR performed the following processing steps for this data collection: Checked for undocumented or out-of-range codes.. Response Rates: The HRMS response rate is roughly five percent each quarter. Datasets:DS0: Study-Level FilesDS1: Public-Use DataDS2: Restricted-Use Data Household population aged 18-64. Each quarterly HRMS sample is drawn from the KnowledgePanel, a probability-based, nationally representative Internet panel maintained by GfK Custom Research. The first quarter 2013 HRMS combines data from the January-February and February-March 2013 pilot surveys. 2019-05-16 Removing variable Q7_F from public datasets and updating documentation.2017-06-30 The principal investigators added a new weight variable to the data file and the technical documentation was updated accordingly.2015-03-25 ICPSR prepared a plain text version of the data with a Stata setup and record layout file. Funding institution(s): Robert Wood Johnson Foundation (71390). Ford Foundation. Urban Institute. web-based survey

The percentage of Americans covered by the Medicaid public health insurance plan decreased from **** percent in 2021 to around **** percent in 2024. However, the percentage of those insured through Medicaid remains lower than the peak of **** percent in 2015. The expansion of Medicaid The Affordable Care Act (ACA) provided the option for states to expand Medicaid eligibility to people whose income was below a particular threshold. The ACA’s major coverage expansion came into force in 2014, and the number of individuals estimated to be enrolled in Medicaid has since surpassed ** million. More than ** million children were enrolled in the program in 2018, representing ** percent of overall Medicaid enrollment. State Medicaid coverage Initially, the ACA mandated that all state Medicaid programs would have to be extended to provide medical coverage to nearly all low-income groups. However, the Supreme Court rejected that part of the act in 2012, leaving the door open for states to make their own decision on whether they expand their plans. As of September 2021, ** states plus the District of Columbia have adopted the Medicaid expansion.

Summary of ACA Medicaid expansion adoption as of January 1, 2017.

Employee Benefits Platform Market Outlook

The global employee benefits platform market size was valued at approximately USD 1.2 billion in 2023 and is projected to reach USD 3.4 billion by 2032, growing at a compound annual growth rate (CAGR) of 12.3% during the forecast period. The rapid growth of this market is driven by the increasing need for organizations to manage employee benefits more efficiently and to attract and retain talent in a competitive job market.

One of the primary growth factors in the employee benefits platform market is the rising awareness among employers about the importance of employee satisfaction and engagement. Companies are increasingly recognizing that providing a comprehensive benefits package can significantly enhance employee morale and productivity. With the growing competition for skilled talent, organizations are investing in sophisticated benefits platforms that offer a wide range of services, from health insurance and retirement plans to wellness programs and flexible work arrangements. This trend is particularly pronounced in industries with high employee turnover rates, such as healthcare and IT.

Another significant driver of market growth is the technological advancements in HR software and cloud computing. The integration of artificial intelligence (AI) and machine learning (ML) into employee benefits platforms allows for more personalized and efficient management of benefits. These technologies enable predictive analytics, which can forecast employee needs and preferences, thereby allowing employers to tailor their benefits offerings more effectively. Additionally, the shift towards cloud-based solutions provides greater flexibility and scalability, making it easier for organizations of all sizes to implement and manage comprehensive benefits programs.

The increasing regulatory requirements and compliance standards across various regions are also contributing to the growth of the employee benefits platform market. Governments and regulatory bodies are imposing stricter guidelines on employer-provided benefits, necessitating the use of advanced platforms to ensure compliance. For instance, in the United States, the Affordable Care Act (ACA) mandates that large employers provide health insurance to their employees, making it crucial for companies to adopt robust benefits management systems. Similarly, European regulations on data protection and employee rights are driving the demand for sophisticated benefits platforms that can handle complex compliance requirements.

Regionally, North America holds the largest market share due to its advanced technological infrastructure and high adoption rate of employee benefits platforms. However, the Asia Pacific region is expected to exhibit the highest growth rate during the forecast period, driven by the expanding corporate sector and increasing awareness about employee welfare in countries like China and India. European markets are also witnessing significant growth, particularly in countries with strong labor laws and employee protection regulations.

Component Analysis

The employee benefits platform market by component is segmented into software and services. The software segment includes platforms that manage various employee benefits programs such as health insurance, retirement plans, and wellness initiatives. This segment is experiencing substantial growth due to the increasing adoption of cloud-based solutions and the integration of AI and ML technologies. These platforms offer enhanced features like predictive analytics, personalized benefits recommendations, and real-time reporting, making them indispensable tools for HR departments.

On the other hand, the services segment encompasses consulting, implementation, and support services provided by third-party vendors. This segment is also witnessing significant growth as organizations seek expert guidance in selecting and implementing the right benefits platforms. Consulting services help businesses identify the most suitable benefits programs for their workforce, while implementation services ensure seamless integration with existing HR systems. Support services, including training and technical assistance, are crucial for maximizing the effectiveness of these platforms.

The software segment is further bifurcated into standalone and integrated solutions. Standalone solutions focus on specific aspects of employee benefits, such as health or retirement benefits, while integrated solutions offer a more comprehensive approach by combining multiple benefits programs into a single platform.

In 2023, just four in ten Medicaid/CHIP enrollees were White, non-Hispanic. In comparison, roughly three-quarters of Medicare beneficiaries were White. The Affordable Care Act (ACA) Medicaid expansion in 2014, has helped reduce racial disparities in access to healthcare in the United States. Medicaid eligibility Medicaid provides health coverage to certain low-income individuals, families, children, pregnant women, the elderly, and persons with disabilities. Each state has its own Medicaid eligibility criteria in accordance with federal guidelines. As a result, Medicaid eligibility and benefits differ widely from state to state. Medicaid expansion provision under the Affordable Care Act (ACA) allows states to provide coverage for low-income adults by expanding eligibility for Medicaid to 138 percent of the federal poverty line (FPL). Medicaid coverage gap Uninsured individuals who live in states that have chosen not to expand Medicaid under the Affordable Care Act (ACA) are referred to as being in the Medicaid coverage gap. As of January 2021, 12 states have not adopted the Medicaid expansion provision under the Affordable Care Act (ACA). More than two million uninsured adults fall into this coverage gap, and among them, more than 60 percent are people of color.

Descriptive statistics for variables used in regression analysis of arrests by Medicaid expansion under the Affordable Care Act, 2011–2013.

Total Medicaid spending surpassed 804 billion U.S. dollars in 2022. The state of California had the highest expenditure throughout the year, followed by New York and Texas.

Federal government helps poorer states Both the federal and state governments fund the Medicaid health care program, but at least 50 percent of the costs incurred by states are matched by the federal government. The exact percentage varies by state because the matching rate was designed so that poorer states receive a larger share of program costs from the federal government. The states of Wyoming, South Dakota, North Dakota, spent the least on Medicaid costs in 2021.

Funding share of states set to increase Under the Affordable Care Act, states have the choice to expand their Medicaid programs to cover nearly all low-income Americans under age 65. For states that implemented the expansion, the federal government paid 100 percent of the state costs for all newly eligible adults from 2014 to 2016. The new matching rate has slowly declined since and reached 90 percent in 2020, which means states have to pick up ten percent of the bill. Governors are concerned about the rise in costs, and state expenditure is projected to increase by 50 percent between 2020 and 2027.

As of January 2025, 1,502 hospitals were part of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). A further 643 thousand physicians and non-physicians were part of ACOs. ACOs are groups of doctors, hospitals, and other health care providers, who voluntarily collaborating to achieve coordinated enhanced quality of care, reduced costs, and improved health outcomes of a designated patient population. ACOs were introduced as part of the Affordable Care Act to shift the U.S. health system from volume-based care (fee-for-service) to value-based care (alternative payment models). When ACOs participating in MSSP spend less than their target (i.e. saves money for Medicare), they receive a share of the savings, that is if they also score well on quality measures. This statistic depicts the number of Accountable Care Organization (ACO) participants in the Medicare Shared Savings Program (MSSP) in the U.S. as of January 2025.

Between 2012/2013 and 2018, the number of beneficiaries assigned to Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) increased steadily from 3.2 million to 10.5 million. The figures have fluctuated since then with a total of 11.2 million beneficiaries assigned to ACOs participating in the MSSP by 2025. ACOs are groups of doctors, hospitals, and other health care providers, who voluntarily collaborating to achieve coordinated enhanced quality of care, reduced costs, and improved health outcomes of a designated patient population. ACOs were introduced as part of the Affordable Care Act to shift the U.S. health system from volume-based care (fee-for-service) to value-based care (alternative payment models). Most ACOs receive payment through Medicare or Medicaid, but an increasing number also contract with commercial (or private) payers.

Between 2012/2013 and 2018, the number of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) increased steadily from 220 to 561. The figures have fluctuated since then with a total of 476 ACOs participating in the MSSP by 2025. The ACOs collectively care for around 11.2 million beneficiaries in 2025, which is roughly one in six Medicare enrollees. ACOs are groups of doctors, hospitals, and other health care providers, who voluntarily collaborate to achieve coordinated enhanced quality of care, reduced costs, and improved health outcomes of a designated patient population. ACOs were introduced as part of the Affordable Care Act to shift the U.S. health system from volume-based care (fee-for-service) to value-based care (alternative payment models). Most ACOs receive payment through Medicare or Medicaid, but an increasing number also contract with commercial (or private) payers.

Between 2012/2013 and 2021, the average overall quality score of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) has fluctuated but generally stayed over 90 percent. Medicare rates the quality of care delivered by ACOs using 33 nationally recognized measures across four domains: patient/caregiver experience, care coordination/patient safety, preventive health, at-risk population (such as diabetics).

ACOs are groups of doctors, hospitals, and other health care providers, who voluntarily collaborating to achieve coordinated enhanced quality of care, reduced costs, and improved health outcomes of a designated patient population. ACOs were introduced as part of the Affordable Care Act to shift the U.S. health system from volume-based care (fee-for-service) to value-based care (alternative payment models). When ACOs participating in MSSP spend less than their target (i.e. saves money for Medicare), they receive a share of the savings, that is if they also score well on quality measures.