The “Affordable Care Act” (ACA) passed in 2010, provided for significant changes to the Medicaid program. It created several new initiatives and opportunities for states under traditional Medicaid. It also provided for the single largest expansion of the program in its history. Learn more about Medicaid & Health Reform.
The law increased Medicaid provider reimbursement rates for 2013-14 for some primary care physicians, including family physicians, general internists, and pediatricians. The raise applies to evaluation and management services as well as immunization administration.
Health Homes Option
The ACA established a new option for state Medicaid programs to establish “health homes” for beneficiaries with chronic conditions.
Health homes provide coordinated care to high-need, high-cost beneficiaries through coordinated primary, acute, mental and behavioral health, and long-term services across the lifespan. Eligible beneficiaries have at least two chronic conditions, or one chronic condition and risk for another, or a chronic condition and a persistent mental health condition.
States that implement the health homes option receive 90% federal matching rates for health homes services in the first two years of the program. So far, six states have received federal approval for their State Plan Amendment to establish health homes.
Accountable Care Organizations
The ACA established a new option for state Medicaid programs to establish Accountable Care Organizations (ACOs). An ACO is a provider-run organization where participating providers are collectively responsible for the care of a patient population and may share any saving associated with improvements in quality and efficiency of care. ACO initiatives are somewhat specific to each state’s history with managed care and other care delivery arrangements.
The law also provided for a significant expansion of the Medicaid program, starting in 2014. However, this provision of the law will be decided on a state-by-state basis. Learn more about Expanded Medicaid.
CMS Answers FAQs on Medicaid and the ACA