Medicaid Nuts and Bolts: Understanding the Program’s Structure, Authorities, and Financing

Program Design Implementation and Assessment

Mar 7

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Medicaid is a complex program with shared responsibilities between the federal government and individual states. Understanding foundational components of the Medicaid program–including its structure, administration, financing, and oversight–can help state legislators and advocates make informed decisions and understand the impact of potential changes. This knowledge is particularly important during transitions in federal administrations, which may result in new policy goals and directives for state Medicaid programs.

Aurrera Health recently partnered with the California Health Care Foundation to develop several resources that provide an overview of the Medicaid program for California legislators and advocates. The resources cover information specific to California’s Medicaid program (called Medi-Cal), as well as topics relevant across state Medicaid programs, including the funding responsibilities of the federal and state governments and state options for tailoring their Medicaid programs. Specific resources include:

Medicaid 101 Slide Deck: This slide deck provides a high-level overview of Medicaid and Medi-Cal and aspects of the federal-state partnership, including federal oversight and options for states to tailor their Medicaid programs. The slide deck describes the content of Medicaid State Plans and how each state can amend their plan via State Plan Amendments (SPA). The slide deck also provides information on two types of federal Medicaid waivers that are commonly used to waive federal requirements for Medicaid programs or pilot new initiatives, Section 1115 Demonstrations and Section 1915(b) waivers. Finally, the slide deck provides information on federal and state shares of Medicaid financing and the use of health care taxes and fees to fund state shares.
SPA vs. Federal Medicaid Waivers Chart: This chart compares the characteristics of SPAs, Section 1115 waivers, and Section 1915(b) waivers to highlight distinctions in submission and approval processes, timelines, fiscal considerations, and more.
CalAIM Federal Authorities Chart: This chart lists the various initiatives being implemented under the state’s expansive CalAIM initiative, which includes a range of widespread reforms and new programs related to behavioral health and social determinants of health. The chart indicates which federal authorities–such as California’s Medicaid State Plan, a Section 1115 waiver, and/or a Section 1915(b) waiver–are used to implement each initiative.

While these resources are specific to California’s Medi-Cal program, they include pertinent information on the structure, administration, financing, and oversight of the Medicaid program that may be beneficial to policymakers and advocates across the nation.

Aurrera Health Group’s Capabilities

If you are interested in learning how Aurrera Health can assist you in informing policymakers and advocates about Medicaid in your state–or our approach to policy analysis on other health policy topics–please reach out to Lauren Block.