While the implementation of other ACA-compliant state-based marketplaces (SBMs) have been marred by technical issues and runaway budgets, the Your Health Idaho marketplace opened with few technical complications and touts an annual budget of less than $9 million.

No two models nor markets are alike, and the pace and prevalence of Medicaid accountable care growth will largely depend on states’ ability to generate savings and successfully overcome common and unique challenges over the long run. This paper contains a state-by-state landscape analysis.

Significant growth in new Medi-Cal enrollees and a lack of growth in agencies willing to provide services to Medi-Cal enrollees suggests an increasing access-to-care gap materializing between Medi-Cal patients and non- Medi-Cal patients for home health services.

This analysis provides four options available to governors and state legislators in the event that Congress and the administration do not succeed in a legislative remedy.