Manatt on Medicaid: Monthly Expansion Recap


Governor Says Federal Officials Committed to Revising State's Medicaid Expansion Waiver

Governor Asa Hutchinson (R) told legislators last week that federal officials were broadly supportive of his plan to amend the State's Medicaid expansion waiver and were committed to finding common ground on the proposed changes. The Governor's plan, called "Arkansas Works," proposes mandatory premium assistance for employer sponsored insurance, a work referral program, and premiums for beneficiaries with incomes above 100% of the federal poverty level. Hutchinson said he will call a special legislative session to consider "Arkansas Works" one week before the State's fiscal session begins in April. The Governor's plan will require three-fourths majority support in the Arkansas House and Senate to become law, after which the State will be required to submit a Medicaid waiver amendment application to the federal government.


Legislature Holds Hearing on Coverage Expansion Bill

The State Senate Health Committee held a hearing on Senate Bill 368, legislation proposing a premium assistance program based on Arkansas's "Private Option" that would cover approximately 300,000 Georgians by permitting Medicaid to purchase qualified health plans on the Marketplace and requiring enrollees to spend up to 5% of their income towards the cost of coverage. The program would be contingent upon receiving a federal match consistent with President Obama's proposal to provide non-expansion states that take up the expansion option the same funding algorithm as states that expanded in 2014. Governor Nathan Deal (R) has historically opposed Medicaid expansion and has not commented on the pending legislation.


Future of Twin Medicaid Expansion Bills Remains Unclear

Legislators in the House Federal and State Affairs Committee and its Senate counterpart introduced identical bills for a Medicaid expansion plan, "Bridge to a Healthy Kansas," late last month, though no hearings have been scheduled for the bills and two attempts to force a floor vote have failed in both chambers. The plan, crafted by the Kansas Hospital Association and modeled after Indiana's expansion program, would extend coverage to approximately 150,000 Kansas residents through KanCare, the State's Medicaid managed care program, and require enrollees above the federal poverty level to make monthly contributions up to 2% of income towards a personal healthcare account. Enrollees would lose coverage if they failed to pay. All non-disabled unemployed adults or those working less than 20 hours per week would be referred to State workforce training and job search resources. While the Legislature and Governor Sam Brownback (R) have historically opposed expansion, the Governor has reportedly indicated a willingness to consider a Medicaid expansion program if it met certain requirements, including budget neutrality.


Former Governor Launches Campaign to Preserve Medicaid Expansion and State-Based Marketplace

Former Governor Steve Beshear (D) announced the launch of his 501(c)(4) organization, Save Kentucky Healthcare, which will campaign to preserve Medicaid expansion and kynect, the State-based Marketplace, both implemented under his administration. Recent reports found these reforms to have had significant economic and health benefits to the State and that they are supported by the majority of Kentuckians. Additionally, a Health Affairs study from the University of Louisville recently found that that the uninsurance rate among low-income adult Kentuckians was reduced from 35% at the end of 2013 to 11% at the end of 2014, a 68% reduction. Meanwhile, Governor Matt Bevin (R), who campaigned on dismantling these reforms, has formed a committee to lead the redesign of the Medicaid program, which includes transitioning the State's "traditional" Medicaid expansion to an alternative expansion that would require federal approval of an 1115 waiver. He has also already begun the process of transitioning kynect to


Medicaid Expansion Bill Remains Under Debate

The bipartisan Medicaid expansion bill introduced last month that would require the State to submit a waiver to expand Medicaid by purchasing qualified health plans on the Marketplace remains under debate. State Medicaid Director Calder Lynch testified in opposition to LB 1032, citing a consultant report commissioned by DHHS that estimates the proposals would cost $1 billion over the next 10 years and could limit access to services, in particular for children and individuals with disabilities. Three previous Medicaid expansion proposals have failed in Nebraska.

New Hampshire

Governor Points to Medicaid Expansion as Lever to Address Opioid Crisis

In her final State of the State address, Governor Maggie Hassan (D) urged lawmakers to reauthorize the State's Medicaid expansion program past its current December 31, 2016 end date, citing its positive impact on the State's economy, public health, and its capacity to deliver substance abuse and behavioral health treatment to combat the State's heroin and opioid crisis. The Governor deemed the crisis "the most urgent public health and public safety challenge facing New Hampshire" and called Medicaid expansion an essential tool in the State's comprehensive approach to addressing it. Since New Hampshire's Medicaid expansion went into effect, 46,000 residents have received coverage under the program, including thousands who have obtained substance abuse and behavioral health services. A bill to continue expansion through 2018 was approved by the House's health committee and is now headed to the House Finance Committee. If the bill makes it out of committee, Senate passage is all but ensured, according to the New Hampshire Union Leader.

New Mexico

Study Finds Medicaid Expansion Is "Paying for Itself"

A report by the University of New Mexico Bureau of Business and Economic Research (BBER) updating a 2012 analysis finds that the State's Medicaid expansion costs are offset by increased revenue and economic gains, and that the program will have a projected total surplus of more than $300 million between fiscal years 2014 and 2020. The analysis considered current and projected enrollment, federal revenue, changes in federal and State uncompensated care programs, and current and projected economic impact of expansion. The study projects deficits from expansion of $21 million in fiscal year 2020 and $51 million in 2021, though the author notes that the study used conservative revenue estimates. In 2014, New Mexico's Medicaid expenditures totaled $4.2 billion.

National News

Obama's Final Budget Proposal Includes Funds for Medicaid Expansion

Among the many initiatives covered in President Obama's $4.1 trillion budget proposal presented to Congress this month is the provision of three years of enhanced federal funding to non-expansion states for the cost of expanding Medicaid regardless of when a state takes up the option. Under current law, funding for Medicaid expansion will be reduced to 95% in 2017 and will phase down to 90% by 2020 for all states. Other proposed budget items include: extending CHIP through 2019; allowing Medicaid providers to negotiate prices for certain high-cost drugs; allowing competitive bidding for medical equipment; and changing the threshold for the so-called "Cadillac tax" (the excise tax on high-cost employer sponsored insurance) to target employer plans with higher costs than the law's current threshold.

Expansion States See the Most Significant Reductions in Uninsured Rates

The national uninsurance rate decreased from 14.4% in 2013 to 9.1% in 2015, a difference of 16 million individuals, according to a report from the Center for Disease Control and Prevention's National Center for Health Statistics. In Medicaid expansion states, the uninsurance rate decreased from 18.4% to 10.0%, compared to 22.7% in 2013 to 17.3% in 2015 in non-expansion states. Of the eight states with the most significant drops in their uninsurance rates between 2013 and 2015, all but one—Florida—opted to expand Medicaid under the Affordable Care Act. The greatest decrease in uninsurance was in Kentucky (6.5 percentage points), where Governor Matt Bevin (R) is currently taking steps to replace the State's Medicaid expansion program with an alternative model requiring a federal waiver, and to dismantle the State-based Marketplace, through which Kentucky residents can sign up for Medicaid. Arizona's 5.9-percentage-point decrease was the second largest.

Uninsured Rate for Working Individuals Drops Twice as Fast in Expansion States

States that expanded Medicaid reduced the number of working individuals without health insurance by an average of 25% between 2013 and 2014, compared to 13% in states that did not expand Medicaid, according to an issue brief by Families USA. The authors note that their conclusions, based on the latest Census Bureau data, is evidence of a strong connection between Medicaid expansion and lower uninsurance rates for working individuals.

8.8 Million Uninsured Are Eligible for Medicaid or CHIP

More than a quarter of the nation's 32.3 million non-elderly uninsured individuals (8.8 million) are eligible for Medicaid or CHIP, and of the uninsured and eligible, 77% (6.8 million) live in states that have expanded or are moving forward with expanding Medicaid, according to the Kaiser Family Foundation. The percentage of uninsured individuals that are eligible for Medicaid is higher in expansion states (41%) versus non-expansion states (13%). Across all non-elderly uninsured and eligible individuals, half have incomes below poverty, just under 60% are people of color and three-quarters have part-time or full-time workers in the family.



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