Medicaid at a Crossroads The 25 th Princeton Conference May 23, 2018 - PowerPoint PPT Presentation

Medicaid at a Crossroads The 25 th Princeton Conference May 23, 2018 Michael Doonan, Ph.D. Brandeis University Michael Doonan May 23, 2018

Medicaid’s Ideological Divide W elfare Program Universal Coverage  Temporary  Standardization  Needy  All low income  Hard to get on  Easy to get on  Easy to get off  Hard to get off  Disincentive to work  Right  Protect public  Social responsibility resources Michael Doonan May 23, 2018

Policy Preferences W elfare Program Solid Safety Net  Work requirements  Income based eligibility  Redeterminations  Presumptive eligibility  Cost sharing  No out of pocket  Asset tests  No asset tests  Detailed applications  Streamlined application  Time limits  Annual enrollment  Minimal benefits  Generous benefits  Waitlists  Transitions Michael Doonan May 23, 2018

Political Pathways  Waivers  Executive orders  Legislation  Courts  Federalism/ State flexibility Michael Doonan May 23, 2018

Axioms  Conservatives use the federal government as much as liberal, they just have different goals.  State flexibility is code word for “I can’t nationalize it.”  Progressive states are progressive with federal money.  Federalism is grease for the system. Michael Doonan May 23, 2018

Middle Ground or Battle Grounds? Matt Salo Executive Director National Association of Medicaid Directors Nina Owcharenko Schaefer Senior Research Fellow The Heritage Foundation Sara Rosenbaum Milken Institute School of Public Health The George Washington University Michael Doonan May 23, 2018