By Surabhi Dangi-Garimella, Ph.D.

A Kaiser Family Foundation (KFF) survey among the Medicaid Directors of 47 U.S. states and Washington D.C., conducted in the summer of 2021, found a deep impact of the pandemic on Medicaid policies and program spending. More than 50% of the states that responded reported expanding their programs to address social determinants of health, while 75% shared that they had initiatives in place to address health disparities. 

The report shared information on 5 key themes: delivery systems, benefits and telehealth, social determinants of health (including information on health equity and COVID-19 vaccine uptake), healthcare provider rates and taxes, and pharmacy. The focus was on policies that were in place in state Medicaid programs in fiscal year (FY) 2021 and changes being planned or implemented in FY 2022. Here are a few key findings from the report:

Delivery Systems

  • 75% of Medicaid enrollees in a majority of states that have managed care organizations (MCOs) were enrolled in the MCOs in July 2021
    • Children and adults were more likely to be enrolled 
    • Elderly or those with disabilities were less likely to be enrolled
  • Enrollment in Medicaid MCOs has been steadily rising since the pandemic began

Benefits and Telehealth

  • Interestingly, more states temporarily expanded benefits and/or waived prior authorization requirements during the COVID-19 pandemic, instead of restricting them. Done using the support of Medicaid emergency authorities, states have the option of making these changes permanent post-pandemic. 
  • Overall, telehealth services were particularly beneficial during the pandemic to maintain or expand access to care—telehealth utilization significantly increased among Medicaid and CHIP enrollees. Coverage varied between audio-visual versus audio-only services and utilization varied between states. While these findings could influence states’ decision to continue providing telehealth services, they will have to weigh access to care against quality concerns. 

Social Determinants of Health

    • Most states had to expand their Medicaid programs to address pandemic-related social determinants of health, such as food and housing insecurity
    • Medicaid programs are also paying greater attention to health care inequities with a  specific focus on maternal and infant health, behavioral health, COVID-19 outcomes, and vaccination rates
  • MCOs are focused on raising the vaccination rates among their beneficiaries through provider engagement and incentives, member outreach and education, helping with vaccination scheduling and transportation, and partnering with state and local organizations


  • State Medicaid agencies increased their oversight of MCO subcontracts: majority reported forbidding spread pricing in subcontracts with pharmacy benefit managers
  • At least 50% of respondents said they had focused their attention on either expanding or newly initiating efforts to curb prescription drug costs in FY 2021 and/or FY 2022. Many states are also in the process of establishing value-based arrangements with drug manufacturers to control pharmacy spending. 

Despite the uncertainty  associated with the pandemic, there were also important lessons learned, and policy changes adopted for the Medicaid population, during this public health emergency.


Surabhi Dangi-Garimella, Ph.D. is a biologist with academic research experience, who brings her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.