Manatt on Medicaid: Monthly Expansion Recap

Arizona

Appeals Court Hears Arguments in Medicaid Expansion Lawsuit

A three-judge State Appeals Court panel heard an appeal of the Maricopa County Superior Court's decision that Arizona's Medicaid expansion plan was passed legally, according to the Arizona Republic. The initial lawsuit, brought by the Goldwater Institute on behalf of Republican State lawmakers, contends that the hospital assessment used to fund expansion is a tax, requiring a two-thirds supermajority vote in the Legislature.

Arkansas

Medicaid Expansion Increased Access to Care and Improved the Quality of Care, Study Finds

The State's Medicaid expansion, which uses Medicaid funds to purchase private Marketplace coverage for the new adult population, is associated with increased access to primary care, reduced emergency department use, fewer unfilled prescriptions, and improved self-reported quality of care, according to a new brief from The Commonwealth Fund. The study found similar rates of improvement in access and self-reported quality of care across Arkansas's private option expansion model and Kentucky's traditional expansion model, noting that whether a state expands Medicaid is more consequential than the type of coverage offered.

Indiana

State Submits Medicaid Waiver Extension Application to CMS, With Amendments

The State submitted a three-year 1115 waiver extension application for its Medicaid expansion program, known as the Healthy Indiana Plan 2.0, with some amendments, including: coverage lock-outs if required redetermination paperwork is not completed in a timely manner; higher premiums for smokers; continuing waiver coverage for women who become pregnant while enrolled under the waiver, rather than enrolling them in traditional Medicaid; and expanded access to substance use disorder services. The State's waiver expires in January 2018; if approved, the extension would be valid through December 2020. Medicaid expansion in Indiana covers nearly 400,000 individuals with incomes up to 138% of FPL through high-deductible health plans. Deductibles are funded by the enrollee's POWER account, a health savings-like account funded by a combination of enrollee contributions, Medicaid funds, and in some instances, contributions from employers and other third parties.

New Report Disputes Program Evaluation Data in Expansion Waiver Application

A National Public Radio (NPR) analysis of Indiana's Medicaid expansion waiver extension application found that the State used "misleading and inaccurate information" as evidence of the waiver's success. Contrary to information provided in the application, NPR found that the number of expansion enrollees missing required payments into their POWER account, a health savings-like account, is increasing, and that more than half of expansion enrollees did not know they had a POWER account. The report also notes that the patient satisfaction survey data cited by the State was "unreliable," and that the State's claim that some groups of expansion enrollees are using emergency departments less frequently than others was not adjusted to reflect differences in health risks between populations. The waiver extension application is open for public comment on the CMS website through March 17, 2017.

Indiana and Michigan

Premiums May Deter Medicaid Enrollment Under Waivers

Premiums and complex enrollment policies, key features of Indiana's and Michigan's Medicaid expansion waivers, may deter Medicaid enrollment, according to a Kaiser Family Foundation analysis of waiver implementation in Indiana and Michigan. The brief also finds that health savings accounts and healthy behavior incentives, both included in Indiana and Michigan's waivers, may be challenging for consumers and stakeholders to understand without sufficient educational outreach.

Kansas

House Passes Medicaid Expansion Bill, Senate to Vote in March

The State House of Representatives passed a bill by an 81-44 margin that would expand the State's Medicaid program to include adults with income below 138% of FPL, or about 300,000 Kansans. The bill instructs the State's Department of Health and Environment to submit a waiver request to CMS to establish a work requirement for the expansion population and provide premium assistance to low-income individuals with employer-sponsored insurance. The bill now advances to the Senate, which will reconvene on March 6. Earlier this week, the bill was expected to be put on hold for the remainder of the legislative session.

Maine

Measure to Expand Medicaid Qualifies for November 2017 Ballot

A voter petition effort to expand Medicaid in Maine successfully submitted 66,434 valid signatures, qualifying for placement on the November 2017 referendum ballot. The Maine Legislature will now consider Medicaid expansion legislation as directed by the petition, and can pass it into law without any amendments or send the question to voters in November.

Michigan

Uncompensated Care Costs Dropped by 48% After Medicaid Expansion

Uncompensated care costs for Michigan hospitals were 2.9% of total costs in 2015, down from 5.2% in 2013 before the State expanded Medicaid, according to a University of Michigan report. In 2013, hospitals spent a total of $627 million on uncompensated care, compared to $327.1 million in 2015.

New Jersey and Ohio

Governors Support Continuation of Medicaid Expansion

New Jersey Governor Chris Christie (R) and Ohio Governor John Kasich (R) have expressed their support for continuing coverage of the Medicaid expansion population, regardless of ACA repeal. Governor Christie said that "there can be lots of ways to make sure" individuals can maintain coverage, though he continues to support ACA repeal. Governor Kasich similarly voiced support for continued coverage for the Medicaid expansion population, while calling for simultaneous ACA repeal and replacement.

Ohio

Proposed Executive Budget Maintains Medicaid Expansion

Governor John Kasich's (R) 2017-2018 executive budget recommends maintaining coverage for Ohio's Medicaid expansion population and proposes that childless adults with incomes "above poverty" pay a $20 monthly Medicaid premium. The premium proposal, which is projected to save Ohio $200 million over two years, would require federal approval under a waiver. Additional budget proposals include a reduction in hospital and nursing home provider rates and implementation of a provider tax on managed care companies.

National News and Reports

Republican Governors Outline Capped Funding Options for Medicaid

A draft plan proposed by Republican governors at the National Governors Association Winter Meeting would allow states to choose either a per capita cap or block grant financing structure for their Medicaid populations, according to a leaked version obtained by multiple news outlets. Republican governors also proposed options in areas where consensus has not yet been reached, including around whether to allow states the option to keep the existing Medicaid financing structure for the expansion population, rather than adopting a per capita cap or block grant, and whether to limit the enhanced federal match for the expansion population to individuals with incomes under 100% of FPL. The draft plan would also grant new flexibility to states over program eligibility, benefits, use of managed care, and provider payment.

At Least Two Republican Senators Oppose Repeal of Medicaid Expansion

Two Republican Senators have publicly opposed repealing the ACA Medicaid expansion, raising fresh questions about whether the Republican leadership will have enough votes to pass a repeal bill that eliminates the expansion. Shelley Moore Capito of West Virginia stated on Wednesday that a bill repealing the expansion would be "a major source of concern" and that she does not believe Republicans will ultimately include it in final legislation. Lisa Murkowski of Alaska also recently said that she would not vote to repeal the expansion, and Susan Collins (R) of Maine may be wavering in her support. Republicans cannot lose more than two votes in the Senate if they want to advance any repeal and replace legislation.

New Tool Compiles and Summarizes Research on Effects of Medicaid Expansion

A Kaiser Family Foundation issue brief and tables review findings from 108 studies released between January 2014 and January 2017 on the impact of Medicaid expansion. The collected body of literature suggests that Medicaid expansion has increased coverage, affordability, and utilization, and has provided states with economic benefits through reduced uncompensated care and increased employment.