Health Policy Center Authors
Publications by Matthew Buettgens for Health Policy Center
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More about Matthew Buettgens's areas of expertise can be found on this Urban Institute expert's page.
Using Past Income Data to Verify Current Medicaid Eligibility (Research Report)
Stan Dorn, Matthew Buettgens, Christopher Hildebrand, Habib Moody
Using data from the 2008 Survey of Income and Program Participation, we find that information about past income and employment that is available to state Medicaid programs can potentially verify (a) initial financial eligibility for between 55 and 79 percent of eligible applicants and (b) renewed eligibility for between 60 and 71 percent of eligible enrollees. Verifying eligibility based on data matches, rather than documentation from consumers, could lower administrative costs; cut paperwork burdens for consumers, thereby increasing participation levels among those who qualify for help; and prevent eligibility errors.
Administrative Renewal, Accuracy of Redetermination Outcomes, and Administrative Costs (Research Report)
Stan Dorn, Matthew Buettgens
When a Medicaid beneficiary approaches the end of a 12-month enrollment period, coverage should be "administratively renewed," according to ACA a regulation, if "reliable information" shows the beneficiary remains eligible. The beneficiary is sent a notice explaining the basis for renewal and the legal duty to make needed corrections. If none are forthcoming, coverage continues. We find that using administrative renewal should lower the number of mistaken outcomes if it is used with beneficiaries known to have an 80 percent or greater likelihood of eligibility. However, administrative renewal will change most mistakes from incorrect terminations to incorrect renewals.
Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States (Research Report)
Matthew Buettgens, Genevieve M. Kenney, Hannah Recht, Victoria Lynch
This report examines how many of the uninsured in each state would be eligible for health coverage assistance programs - i.e. Medicaid, the Children's Health Insurance Program and subsidized private coverage through the new health insurance marketplaces - under the Affordable Care Act. The report also estimates the anticipated decrease in the uninsured population under the ACA in each state. Finally, the report examines the share of those remaining uninsured under the ACA in each state who would be eligible for, but not enrolled in, assistance programs.
No Wrong Door: Improving Health Equity and the Health Coverage Consumer Experience in Connecticut (Policy Briefs)
Matthew Buettgens, Stan Dorn
"No Wrong Door" (NWD) is a system that allows consumers to apply for health insurance through different agencies, and then seamlessly routes them to the program for which they qualify. We find that over the course of a year under the Affordable Care Act, NWD would prevent 36,000 Connecticut residents from losing health insurance coverage for at least part of the year. Connecticut's leaders have committed to full implementation of NWD by the end of 2015. If this commitment is fulfilled, significant gains will result for both state government and residents. However, monitoring implementation in the transition period is critical.
The Cost of Not Expanding Medicaid (Research Report)
John Holahan, Matthew Buettgens, Stan Dorn
As states make decisions about whether to implement the Medicaid expansion under the Affordable Care Act, this new analysis highlights the implications of these decisions for coverage, state finances, and providers. The results show that the decisions by as many as 27 states not to adopt the Medicaid expansion will leave 6.4 million people who could have been eligible for Medicaid uninsured. States that do not expand Medicaid will forego significant federal funding, which could have had a positive impact on state economies and general revenues. Moreover, hospitals in these states will receive substantially less revenue than they would have had the state expanded coverage while they will still have to serve a large uninsured population. These findings present a strong economic case for Medicaid expansion.
It's No Contest: The ACA's Employer Mandate Has Far Less Effect on Coverage and Costs Than the Individual Mandate (Policy Briefs/Timely Analysis of Health Policy Issues)
Linda J. Blumberg, John Holahan, Matthew Buettgens
The Obama administration announced a 1-year delay in imposition of penalties for large employers who do not offer affordable coverage to their full-time workers under the Affordable Care Act (ACA). The announcement led to some suggesting that the employer penalties amounted to a key component of the ACA, and others stating that it was "unfair" to delay employer penalties but to leave the penalty on individuals in place. However, our analysis shows that the ACA can achieve all its major objectives without the employer mandate. Conversely, the individual mandate is a central component of the law and its coverage expansion.
Documentation on the Urban Institute's American Community Survey Health Insurance Policy Simulation Model (ACS-HIPSM) (Research Report)
Matthew Buettgens, Dean Resnick, Victoria Lynch, Caitlin Carroll
The model documented here builds off of the Urban Institute's base HIPSM, which uses the Current Population Survey (CPS) as its core data set, matched to several other data sets including the Medical Expenditure Panel Survey-Household Component (MEPS-HC), to predict changes in national health insurance coverage and spending under ACA using a micro-simulation modeling approach. To create HIPSM-ACS, we apply the core behavioral estimates coming from base HIPSM to ACS records (using a series HIPSM-estimated imputation models) to exploit the much larger sample size for more precise estimates at the state and sub-state level.
Expanding Medicaid in Ohio: Analysis of Likely Effects (Research Report)
Stan Dorn, Matthew Buettgens, Caitlin Carroll, Additional Authors
Adding Medicaid expansion to the remainder of the Patient Protection and Affordable Care Act (ACA) would increase Ohio’s Medicaid costs between $2.4 and $2.5 billion during FY 2014 to 2022. The state could reduce $1.5 billion in spending on medically needy adults, inpatient prison costs, and other services to the poor uninsured. Expansion would yield $2.7 and $2.8 billion in new revenue, including premium taxes, general revenue from economic activity generated by increased federal Medicaid dollars, and prescription drug rebates. Altogether, expansion would generate between $1.8 and $1.9 billion in net state budget gains while covering more than 400,000 uninsured.
The Financial Benefit to Hospitals from State Expansion of Medicaid (Research Report)
Stan Dorn, Matthew Buettgens, John Holahan, Caitlin Carroll
State decisions to expand Medicaid have important implications for hospitals. There are a number of provisions in the Affordable Care Act that will reduce hospital payments - lower rates of Medicare reimbursement and cut backs in Medicare and Medicaid disproportionate share hospital payments. On the other hand, hospitals stand to gain considerably from the added insurance coverage because of the Medicaid expansion. Fewer uninsured will mean higher revenues to hospitals. However, some newly covered Medicaid patients will have formally been privately insured. For these patients, Medicaid will typically pay less than private insurance. On balance, we show that for each $1.0 in private revenue that the Medicaid expansion eliminates, hospitals Medicaid revenue increases by $2.59.
Why the ACA's Limits on Age-Rating Will Not Cause "Rate Shock": Distributional Implications of Limited Age Bands in Nongroup Health Insurance (Policy Briefs/Timely Analysis of Health Policy Issues)
Linda J. Blumberg, Matthew Buettgens
Insurers are calling attention to a potential "rate shock" that will push young adults out of the nongroup insurance market under the ACA due to limitations on premium differences by age. We compare the impact of the ACA's 3:1 rate band to a "looser" 5:1 alternative. Loosening the bands would have very little impact on out-of-pocket rates paid by the youngest purchasers once subsidies are taken into account. Also, the majority of young adults currently purchasing nongroup coverage will also be financially protected by the exchange subsidies, the ACA's Medicaid expansion, and the expansion of dependent coverage to young adults.