Manatt on Medicaid: Monthly Expansion Recap


Task Force Report Highlights Expected Cost Savings From Medicaid Expansion

The Arkansas Health Reform Legislative Task Force met for the last time to approve its final report, which includes findings and recommendations on health coverage in Arkansas, including the finding that continuing Medicaid expansion would save the State $637 million from 2017 to 2021. The report also estimates that changes already underway, including capping some mental health benefits and allowing managed care organizations to manage dental benefits, will yield an additional $963 million in savings over the next five years. The Task Force was created by Governor Asa Hutchinson (R) in January 2015 to study broader reforms to the State Medicaid program.

CMS Approves Five-Year Extension of Medicaid Expansion Waiver

CMS approved the State’s 1115 waiver extension to implement Arkansas Works, which will continue providing coverage through qualified health plan (QHP) premium assistance, while implementing a new employer-sponsored insurance (ESI) premium assistance program for enrollees who have access to cost-effective ESI through a participating employer. The demonstration will also require premiums for beneficiaries with incomes above 100% of FPL, establish an incentive benefit to encourage premium payment and healthy behaviors, refer enrollees to work and work training opportunities, and waive retroactive eligibility on the condition that the State eliminate a backlog of Medicaid cases and implement hospital presumptive eligibility. Arkansas Works took effect January 1, 2017.


House Democrats Continue to Push for Medicaid Expansion

House Minority Leader Stacey Abrams (D) said State House Democrats will continue to push the State to expand Medicaid in the new legislative session. "I think the responsibilities of Democrats is to demand that if we are not going to take the obvious solution, then demand to Republicans what are you going to do about the healthcare crisis facing Georgia?" Abrams said.


CMS Approves Continuation of Non-Emergency Transportation Waiver

The State's request to extend its temporary waiver of non-emergency medical transportation (NEMT) in its Medicaid expansion program has been approved through January 31, 2018. CMS will work with the State on a federal evaluation to analyze the impact of the NEMT waiver. The waiver excludes certain populations, such as pregnant women and the medically frail. CMS has approved a small number of time-limited NEMT waivers and has recently received similar requests for extensions from Arkansas and Kentucky.


Kansas Health Institute Revises Medicaid Expansion Enrollment Estimates

The Kansas Health Institute (KHI) estimates that 152,000 individuals over 10 years would enroll in Medicaid and CHIP if the State expanded Medicaid, down from an earlier estimate of 240,000 new enrollees. The revised estimate reflects new survey data showing more insured Kansans, and revisions to expected take-up rates for expansion and previously-eligible populations. The report also shows higher estimates of the per capita cost for expansion enrollees, and reflects a drop in federal support for expansion beginning in 2017 under the ACA. The revised net costs to the State remain in the same range as earlier projections, and do not include possible offsetting savings, such as reduced State costs for uninsured Kansans or existing Medicaid populations.


Automatic Pre-Release Inmate Medicaid Enrollment Program Scheduled for January 1 Launch

Seven State prisons were scheduled to begin automatically enrolling prisoners in Medicaid in preparation for their release, as of January 1, according to Department of Corrections and Department of Health officials, quoted in media coverage. The program uses an automated file transfer program to enroll prisoners, link them to a managed care plan, and connect high-need prisoners to care management prior to release. The State has been developing the program since June 2016, in concert with roll out of the Medicaid expansion. The initiative is expected to expand to locally-operated facilities in subsequent phases.


Enough Signatures Collected to Place Medicaid Expansion on Ballot

More than 65,000 Maine voters signed a petition organized by Maine Equal Justice Partners, an Augusta-based advocacy group, to place Medicaid expansion on the ballot. The signatures must be filed before January 26, 2017 to allow Medicaid expansion to appear on the November 2017 ballot.

New Jersey

One in Ten Adults Would Lose Coverage if Medicaid Expansion Is Repealed

More than 500,000 adults, or 10% of the State’s adult population, will lose health coverage if Medicaid expansion is repealed, according to a new report from the non-profit and non-partisan group New Jersey Policy Perspective. Repeal would also cost the State $3 billion in federal funding in 2018 and over $11 billion by 2021, compounding the State’s existing financial crisis. The study authors call on the State’s congressional delegation to oppose ACA repeal and on Governor Chris Christie (R) to encourage President-elect Donald Trump to maintain expansion.


Governor Halts Medicaid Expansion Efforts

Governor Matt Mead (R) announced he will no longer pursue Medicaid expansion in light of the Presidential election, according to the Casper Star Tribune. Governor Mead has long supported Medicaid expansion for Wyoming, but the State's Republican-controlled Legislature has rejected expansion bills multiple times. Although the Governor opposed the ACA when it was passed, he has supported expansion because of the federal dollars it would bring to the State.

National News and Reports

Billions in Federal Funding to States at Risk Under Medicaid Expansion Repeal, Report Finds

An estimated 11 million Medicaid enrollees, or 14% of the Medicaid population, will lose health coverage if the Medicaid expansion is repealed, and states will lose $79 billion in federal funding, according to a Kaiser Family Foundation report. A second report from the Robert Wood Johnson Foundation and Manatt Health highlights key questions for states regarding the implications of expansion repeal. The report notes that federal dollars committed to financing the Medicaid expansion would be at risk under repeal, and that Congress may need to raise taxes, increase the debt, or cut spending on other programs to later restore repealed funding for states.

Comprehensive White House and HHS Report Highlights ACA Impacts, Consolidates Related Federal Data

A new report and data compilation, released by the White House Council of Economic Advisers and HHS, reviews the economic and coverage implications of the ACA. The report notes a “growing body of evidence” demonstrating the benefits of the ACA both for healthcare coverage and the healthcare system overall. The report highlights estimates that the ACA has resulted in: $3 trillion in reduced deficits over the next two decades; 20 million individuals gaining coverage; an uninsurance rate below 9%; and 24,000 deaths avoided per year. The data compilation includes over 70 of these types of metrics by state that have been updated from previous reports, including: changes in uninsurance rates; Medicaid coverage gains and trends; and uncompensated care spending.

Report Finds Uninsurance Rates Would Double Under ACA Repeal

The number of people without insurance would more than double, from 28.9 million in 2019 to 58.7 million in 2019, if the ACA is partially repealed through reconciliation, according to a new analysis by the Urban Institute. The uninsurance rate would increase from 11% to 21%, higher than it was prior to the ACA. The report compares coverage and federal spending under the ACA to coverage and spending under a previous reconciliation bill that President Obama vetoed in January 2016. Of the 29.8 million people who would lose coverage, 22.5 million people would become uninsured as a result of eliminating the premium tax credits, the Medicaid expansion, and the individual mandate; 7.3 million would lose coverage due to the “near collapse” of the individual market. Federal healthcare spending would be reduced by $109 billion in 2019 and by $1.3 trillion from 2019 to 2028. State spending on Medicaid and CHIP would fall by $76 billion between 2019 and 2028, and reconciliation would add $1.1 trillion in uncompensated care costs for the uninsured.



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