Stakeholder Impact and Analysis: Medicaid Extenders Act of 2019

This report provides a comprehensive analysis of the Medicaid Extenders Act of 2019 (H.R. 259), examining its origins, legislative history, and the context of preceding legislation like the Affordable Care Act and the Money Follows the Person program. The report details the bill's proposed changes, including funding for the Money Follows the Person program and extensions of Medicaid eligibility criteria, and discusses the reasons for its enactment. It identifies key stakeholders, such as the government, patients, healthcare providers, insurance companies, and advocacy groups, and evaluates the impact of the Medicaid expansion on each group. Furthermore, the report addresses the limitations of the Act and explores potential solutions, such as the proposed "Medicare for All" plan. The analysis covers the benefits of Medicaid expansion, including improved access to care and financial security for patients, as well as its impact on healthcare providers, insurers, and pharmaceutical companies. The conclusion summarizes the Act's goals and the ongoing efforts to expand health insurance coverage, particularly for low-income individuals and children.

Running head: A BIG PICTURE OF THE MEDICAID EXTENDER ACT 2019
A Big Picture of the Medicaid Extenders Act 2019
Name of the Student
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1A BIG PICTURE OF THE MEDICAID EXTENDERS ACT 2019
Executive Summary
The Affordable Care Act was proposed to provide health insurance to the previously
uninsured people through Medicaid facilities. The Medicaid Extenders Act was enacted to
expand the coverage to peoples having a salary, which is nearly 135 per cent of the Federal
Poverty Level, including people who have mental problems1. This paper aims to provide
information on the Medicaid expansion and its impact upon its stakeholders.

2A BIG PICTURE OF THE MEDICAID EXTENDERS ACT 2019
Table of Contents
Introduction................................................................................................................................3
Discussion..................................................................................................................................3
Origin and genesis of the bill.................................................................................................3
History of Medicaid Extender Act.........................................................................................4
Reason of failure of the “Medicaid Extender Act”................................................................4
The solution to the issue.........................................................................................................4
Stakeholders of bill................................................................................................................5
Impact of Medicaid Expansion on Stakeholder.....................................................................5
Conclusion..................................................................................................................................6
REFERENCE.............................................................................................................................7

3A BIG PICTURE OF THE MEDICAID EXTENDERS ACT 2019
Introduction
The Medicaid Extenders Act of 2019 was proposed with a vision to bring a change,
particularly in programs regarding Medicaid and funding2. The act provides allotment for the
fiscal year 2019 and revises on the whole “Money Follows the Person Rebalancing
Demonstration” plan of action. This plan says that the “Centers for Medicare & Medicaid
Services” should arrange allowance to Medicaid programs of the States for assisting them in
increasing long-term health service and reduce the usage of institutional care. Moreover, the
bill serves to extend the criteria for Medicaid eligibility application that protests against
marital impoverishment. The given act helps to provide medical facilities to states who have
failed to execute asset-verification programs successfully to determine Medicaid
affordability.
Discussion
Origin and genesis of the bill
The Money Follows the Person (MFP) program was established by “The Centers for
Medicare Services” in 2005, which provides Medicaid facilities to recipients who need to
relocate from clinical to community-based healthcare. The Affordable Care Act helped to
strengthen and expand the program to many more states. Although many people have
successfully transitioned home through the grant process, however, when the program
expired in 2016, most States associated with the program entirely consumed their funding by
late 2018. To find a solution to the problem, Frank Pallone and Greg Waldon3 initiated the
Medicaid Extenders Act of 2019, which funds the Money Follows the Person program

4A BIG PICTURE OF THE MEDICAID EXTENDERS ACT 2019
through March 2019 and expands protections against marital impoverishment to people in
home-based and community-based services.
History of Medicaid Extender Act
The acts which were proposed before The Medicaid Extenders Act 2019 are Money Follows
the Person program and Consolidated Appropriation Act 2019.
The aim of the Money Follows the Person Act act was as follows:
 Encouraging more home-based and community-based services
 Eliminate hurdles regarding Medicaid policies which hampers the usage of Medicaid
funds helping people to receive care for a long time
 Strengthen the potential of Medicaid to provide home-based service and community-
based services to people who wants to break through from institutional settings
 To ensure quality assurance and advancement in home and community-based services
Reason of failure of the “Medicaid Extender Act.”
“The Medicaid Extender Act” is not well accepted by the ordinary people due to some
limitations associated with it. If an individual is below the poverty level or has a low income,
then that person will not qualify for enjoying Medicaid facilities. Medicaid facilities were
proposed to support people with low income5 and disabilities. However, in some states,
Medicaid facilities are only covered for people having a profit, which is way above the
poverty level. The rest are not entertained.
The solution to the issue
To address this issue, “The Medicare for All” was proposed to eliminate the
prevailing discrepancies based on eligibility, financial status, the payment delivery system
along with complex enrollment and renewal process4. The primary aim of this program is to

5A BIG PICTURE OF THE MEDICAID EXTENDERS ACT 2019
ensure uniform coverage for health care service to everyone irrespective of their economic
and social status. Undocumented immigrants would also be allowed to apply for Medicaid
services. The most rudimentary change under “Medicare-for-all” is to provide consistent
coverage of community-based health services for the long term.
Stakeholders of bill
The stakeholders of the said bill constitute the government. The patients, health
professionals or doctors, pharmacists, health insurance companies, and the advocacy
community7. Because of the complexities regarding public health effort, stakeholders are
recruited whose responsibility is to ensure that the right evaluation protocol is being followed
and the implementation of the same will be able to create a change in the overall health
status.
Impact of Medicaid Expansion on Stakeholder
Medicaid service immensely supports the patients by providing efficient health care
services and treatment at a low cost. It has granted better access to care, service utilization
and financial security among the population. The expansion in Medicaid also led to a
reduction in the uncompensated care cost for hospitals and clinics8. Physicians or doctors are
primarily involved in patient care and treatment, thus having the maximum responsibility.
Medicaid expansion brought people with new requirements for education and interventions
from pharmacists. A pharmacist also needs to increase their knowledge and level of expertise
and intervention efforts to serve the patients in a better way. To improve health outcomes,
they can adopt new strategies regarding the lower spending of drugs and increasing
adherence and collaboration with doctors(Ghosh et al9 ). The Medicaid expansion benefits the
health insurers also. They are involved in the management of Medicaid care and offer health
insurance in both private and smaller markets. The insurance companies are engaged in

6A BIG PICTURE OF THE MEDICAID EXTENDERS ACT 2019
selling health coverage to patients directly or by indirect means through government
intermediaries10. The pharmaceutical firms and insurance companies are mainly responsible
for expanding the wealth of the stockholder.
Conclusion
Though the Medicaid Expansion Act was proposed to provide health insurance to
people with low income, facilitating the easy accessibility and affordability of health care to
people, still there are some states which are barred from enjoying the Medicaid service
because of their low income( 135% at or below the Federal Poverty Level). So, recently
another bill called Medicare for all was proposed to expand and spread the health insurance
coverage to more people, including the uninsured children who cannot afford the Medicaid
facilities.

7A BIG PICTURE OF THE MEDICAID EXTENDERS ACT 2019
REFERENCE:
1. Poverty Line Proposal Would Cut Medicaid, Medicare, and Premium Tax Credits,
Causing Millions to Lose or See Reduced Benefits Over Time. Center on Budget and
Policy Priorities. https://www.cbpp.org/research/poverty-and-inequality/poverty-line-
proposal-would-cut-medicaid-medicare-and-premium-tax. Published 2020. Accessed
February 19, 2020.
2. Amendments - H.R.259 - 116th Congress (2019-2020): Medicaid Extenders Act of
2019. Congress.gov.
https://www.congress.gov/bill/116th-congress/house-bill/259/amendments. Published
2020. Accessed February 19, 2020.
3. Medicaid Extenders Act of 2019 (H.R. 259). GovTrack.us.
https://www.govtrack.us/congress/bills/116/hr259. Published 2020. Accessed
February 18, 2020.
4. Sanders.senate.gov. https://www.sanders.senate.gov/download/medicare-for-all-2019-
summary?id=FA52728F-B57E-4E0D-96C2-
F0C5D346A6E1&download=1&inline=file. Published 2020. Accessed February 19,
2020.
5. Labblog.uofmhealth.org. Benefits of Medicaid Expansion to Low Income Adults |
Michigan Medicine. Labblog.uofmhealth.org.
https://labblog.uofmhealth.org/industry-dx/primary-care-providers-cite-benefits-of-
medicaid-expansion. Published 2020. Accessed February 12, 2020.
6. www.kff.org. The Effects of Medicaid Expansion under the ACA: Updated Findings
from a Literature Review. The Henry J. Kaiser Family Foundation.
https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-

8A BIG PICTURE OF THE MEDICAID EXTENDERS ACT 2019
the-aca-updated-findings-from-a-literature-review-august-2019/. Published 2020.
Accessed February 12, 2020.
7. Stakeholder Engagement | CMS. Cms.gov. https://www.cms.gov/Medicare/Quality-
Initiatives-Patient-Assessment-Instruments/MMS/Stakeholder-Engagement.
Published 2020. Accessed February 18, 2020.
8. More studies show Medicaid expansion has benefited hospitals. The-hospitalist.org.
https://www.the-hospitalist.org/hospitalist/article/146880/more-studies-show-
medicaid-expansion-has-benefited-hospitals. Published 2020. Accessed February 18,
2020.
9. Ghosh A, Simon K, Sommers B. The Effect of State Medicaid Expansions on
Prescription Drug Use: Evidence from the Affordable Care Act. NBER.
https://www.nber.org/papers/w23044. Published 2020. Accessed February 12, 2020.
10. Health insurers migrating to Medicare, Medicaid. Modern Healthcare.
https://www.modernhealthcare.com/insurance/health-insurers-migrating-medicare-
medicaid. Published 2020. Accessed February 19, 2020.