The implementation of ACA sought to reform the current challenges. There are currently six options of reform a state can implement according to the ACA. Each option allows the states to expand opportunities, research, delivery and quality of care. To date nearly every state has adopted at least one provision introduced by ACA. Jackson (2012) states, the ACA required states to expand their Medicaid programs to all individuals under age 65 with incomes below 133 percent of the federal poverty level, or lose all federal Medicaid dollars. The Court found the punishment – not the expansion – unconstitutionally coercive. Congress cannot require the states to take on the expansion by threatening to withhold all current Medicaid funds. However, states can still participate in the expansion and, if they do so, must comply with the requirements the ACA establishes for that part of the program. Each provision provides the state with expansion of Medicaid services and opportunity.
The first provision implementation was the increase of federal funding and expanding the Money Follows the Person demonstration (MFP). In this provision, States are awarded federal grant funding to transition Medicaid beneficiaries out of institutions to their own home. The ACA extends MFP for five more years, until 2016, allocates an additional $2.25 billion to the program, and expands MFP eligibility to include people residing in an institution for more than 90 consecutive days (previously the length of stay criterion was six months to two years). This provision is supportive for patients who have the ability to live in their home rather than in a facility. At the same time, more vulnerable situations are able t...
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...ations of current policies. Currently the provisions allow opportunity for States to make a difference and allow the States to control their vulnerable populations. The new ACA options also present opportunities to improve the coordination of care for populations with chronic and complex health care needs, through the implementation of health home services and the development of financial alignment models for dual eligible beneficiaries. Some states have proposed combining these elements, for example, by designing a financial alignment demonstration based on health homes. Together, all of the new and expanded options for system transformation in the ACA hold promise for improving states’ delivery of Medicaid long-term care and potentially containing the cost growth while remaining responsive to beneficiary needs to receive more services in community-based settings.
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