BURLINGTON, Mass., July 2, 2014 /PRNewswire/ -- Decision Resources Group expects most states to move toward Medicaid expansion in the next few years. Two key factors continue to drive the domino effect:  the financial element, with pressure from hospital systems in non-expansion states that continue to lose millions of dollars on   uncompensated care, not to mention the millions of federal dollars left on the table—and waiver-based initiatives, where states are using the law as a springboard to reshape their respective Medicaid programs. A new Executive Briefing discusses the waiver states that will serve as an example for others, summarizes the three big themes in Medicaid today and highlights how they will affect Pharma.

Key Facts

  • Decision Resources Group's newest Executive Briefing, entitled Medicaid Expansion: The "Dominoes" Continue to Fall, maps out today's Medicaid landscape.
    • As of May 2014, around 170,000 Arkansas residents had enrolled through the Arkansas private option.
    • Michigan's waiver became effective in April 2014—a consumer-engagement approach considered a worthy experiment even by its critics.
    • Indiana is creating two plans to submit for federal approval—Healthy Indiana Plus and Basic—if approved, Oklahoma, Utah, Alaska and Wyoming could be inclined to follow suit.  
    • If Pennsylvania Governor Tom Corbett loses the November election, the state may go for true Medicaid expansion vs. the Healthy PA waiver currently being negotiated with federal officials.
    • Three big themes in Medicaid:
      • While states generally aren't shrinking their use of MCOs, several are expanding managed Medicaid in varying capacities as they seek to restrain healthcare cost increases.
      • With the rise of ACOs in the commercial and Medicare segments, more states than ever before are implementing similar models in their Medicaid programs to coordinate care for the sickest beneficiaries.
      • After an early flurry of interest from 26 states in 2012, just 12 are moving ahead with demonstration projects to coordinate care for those who qualify for full Medicaid and Medicare benefits.
  • The full Executive Briefing can be downloaded here.


  • Ric Gross, Senior Analyst at Decision Resources Group, said: "One noteworthy byproduct of the state-by-state Medicaid expansion battle is the level of experimentation allowed by the Obama administration. Republican-heavy states such as Arkansas and Iowa received CMS permission to move Medicaid expansion beneficiaries into the private exchange. This level of adaptation has prompted other states, such as Indiana, to push for even more liberties in a bid to expand. While CMS won't simply rubber stamp these requests, they certainly want as many states as possible to open up the program and bring more uninsured into the fold."
  • Renee Burnham, Director of Market Access Insights for Decision Resources Group, adds: "Increasingly, state Medicaid programs are focusing on care integration and payment reform so they can improve patient outcomes at a more efficient cost. Pharma companies will want to stay abreast of these changes to maximize their drugs' positioning in these new patient-care models."


  • Decision Resources Group is offering an open webinar based on the new Executive Briefing. Medicaid Expansion "Dominoes": Are Waivers A Continuing Trend or Fleeting Fad? will take place July 24th, 2014 and is open to media, payer, provider, PBM, government and pharmaceutical executives. Register for the webinar here.

About National MCO Analyzer

NEW: Medicaid Profiles, which allow users to evaluate brand opportunity in Medicaid by state, are now part of National MCO Analyzer.

National MCO Analyzer is a report series profiling the nation's top insurers, including their enrollment, market strength and competitive position in the commercial, Medicare Advantage and Medicaid segments—as well as their pharmacy operations, care management, provider contracting and financials. New MCO Commercial Landscape reports provide a frequently updated view of the key pressures, trends and drivers in the marketplace.

About Decision Resources Group

Decision Resources Group offers best-in-class, high-value information and insights on critical issues within the healthcare industry. DRG insights and analysis on the U.S. managed care market are powered by HealthLeaders-InterStudy. Clients rely on this analysis and data to make informed decisions. Find out more at www.hl-isy.com and www.DecisionResourcesGroup.com.

All company, brand or product names contained in this document may be trademarks or registered trademarks of their respective holders.

For more information, contact:
Christopher Comfort 
Decision Resources Group 

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SOURCE Decision Resources Group

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