Scenario you are the director of community affairs for the he

1. Scenario
You are the director of community affairs for the health lobby
organization, Pathways to a Healthy America. In 2010,
President Barack Obama signed the Affordable Care Act into
law. As a result, millions of Americans who were previously
uninsured gained access to the healthcare system. One of the
initial provisions of the Act required individual states to expand
the eligibility criteria for Medicaid. The program’s costs would
be absorbed by the federal government at a rate of 100% for the
first three years of program participation which would decrease
to 90% after 2020, still, considerably higher than previous
funding by the federal government. However, in 2012, the
Supreme Court ruled the mandate unconstitutional allowing
individual states to voluntarily “opt” out of the Medicaid
expansion program. As a result of the various states’ decision to
“opt” out of the ACA’s Medicaid expansion, millions of adults
fell into the critical coverage gap. Your organization represents
a state which has decided to forego participation in the ACA
expansion program. The decision was met with both praise and
criticism.
It has now been a few years since the decision and your
organization has gathered information on the impact of the
decision in order to advocate for Medicaid reform during the
next state legislative session.
You are required to write an advocacy report to state lawmakers
in which you advocate for either participating in the original
expansion program or participating with conditions (waivers) to
address the critical gap in coverage for vulnerable adults in
your state. Waivers such as Section 1115 enable for alternative
implementation of Medicaid expansion and allow states to

2. impose restrictions which may result in a denial of Medicaid
eligibility for individuals who do not meet those restrictions,
i.e., work requirements.
Instructions
Research the Medicaid expansion program offered through the
Affordable Care Act (ACA) as well as Medicaid reform
initiatives using waivers to increase access to Medicaid.
Determine, based on your state’s profile, which process (the
ACA’s expansion program or the use of waivers) is most
beneficial to your state. Include a comprehensive, well -
supported recommendation for participation in Medicaid reform
using
either
the ACA’s program or a modified reform process using
waivers.
Your advocacy report should describe your state’s current
Medicaid program including its eligibility criteria,
demographics, Medicaid spending and savings since the ACA’s
implementation, and comprehensive details of current or
pending waivers. You should also include a discussion
(benchmark) on another state’s success with Medicaid reform
using your recommended strategy (the ACA’s expansion
program
or
the use of the specific types of waivers for which you propose).
RUBRIC:
Report includes a comprehensive, coherent, well thought out
recommendation, for either the ACA’s expansion of Medicaid or
a modified expansion process with a justification based on
comprehensive research with fully developed, well-supported

3. reasoning.
Report includes a comprehensive description of the state’s
Medicaid program including eligibility criteria, demographics,
spending, savings and the state’s current or pending waivers.
Report includes a comprehensive assessment of another state’s
successful reform efforts and a comprehensive, well-supported
discussion on the criteria used in evaluating the implementation
of successful Medicaid reform in that state
Report includes a comprehensive discussion with significant
and current details on the Medicaid expansion program offered
through the Affordable Care Act (ACA). Discussion includes
assertions supported by credible research.
Report includes a comprehensive description of waivers (i.e.,
Section 1115). Discussion includes assertions supported by
credible research.
Includes 3 or more credible, scholarly, current (within the past
5 years), and relevant sources. Adequate integration of
information included within the report. Appropriate synthesis
and analysis included in the report.