State Medicaid Expansion Issues

The Alliance for Health Reform recently held a briefing for reporters at the National Press Club to discuss Medicaid expansion in the states. Alan Weil Editor-in-Chief at Health Affairs commented on how much Medicaid has changed since he ran the Colorado Medicaid program several decades ago. Today, Governors must make important decisions related to Medicaid as many states are implementing their own health initiatives.

Marilyn Serafini, Vice President for Policy at the Alliance introduced the featured speaker Arkansas Governor Asa Hutchinson who told the attendees that Medicaid is now the single largest source of health insurance in the nation.

Medicaid programs are currently undergoing transformation and pursing a combination of reforms in their programs. The states are dealing with incorporating Medicaid service payments to deliver value outcomes rather than volume of services, how to integrate care particularly behavioral health and long term care, how to utilize support from the Federal government where appropriate, and lastly how to provide for long term Medicaid program sustainability.

Governor Hutchinson in D.C for the National Governors Meeting commented that if Medicaid isn’t expanded, the state budget will suffer so options must be considered. He plans to sit down with the other Governors to discuss such issues as possible waivers and innovations in the states related to Medicaid.

One of Governor Hutchinson’s main points is that Employer-Sponsored Insurance (ESI) premium assistance needs to be encouraged. When the ESI is available, employees will have to take it, however, premium assistance would be available to the employee to help with the deductible and co-pay.

States may request “1332 Waivers” from HHS for certain requirements. The Governor is looking towards some Federal support so Arkansas legislators are considering legislation requiring the state to pursue 1332 waivers to complement these changes.

The Governor feels strongly that work training must be provided to incentivize, encourage, people to work, and provide them with opportunities. If an individual is able but unemployed or under-employed based on income thresholds, that individual would be required to be referred to work training and employment assistance programs.

In a letter dated February 16, 2016, Secretary of HHS Secretary Sylvia M. Burwell sent a letter to Governor Hutchinson supporting his goal to incentivize work. She plans to contact her counterparts in other agencies to discuss options to make job training and employment more attractive for residents in states so that individuals are better connected to the workforce.

In other news related to Medicaid expansion, Kentucky was one of two southern states to expand Medicaid under ACA. However, recently, the newly elected Kentucky Governor Matt Bevin announced that he would discontinue the expansion.

Health Affairs has just released a study titled “Kentucky’s Medicaid Expansion Showing Early Promise on Coverage and Access to Care”. The study completed before the Governor of Kentucky’s announcement evaluated the impact of Medicaid expansion in Kentucky through 2014.

The study reports that un-insurance among nonelderly residents in Kentucky with incomes up to $25,000 declined from 35 percent at the end of 2013 to 11 percent in late 2014. The study provides evidence on the benefits experienced because of Medicaid expansion.

Support for the briefing was provided by the Jayne Koskinas Ted Giovanis Foundation for Health and Policy


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