Manatt on Medicaid: Monthly Expansion Recap

National News and Reports

Governors Voice Support for Maintaining the Medicaid Expansion

Democratic Governors, joined by some of their Republican colleagues, are actively making the case to Congress for maintaining Medicaid expansion. In response to a letter from Representative Kevin McCarthy (R) asking for input, they uniformly highlighted the benefits of expansion and expressed strong opposition to ACA repeal. Republican Governors, such as John Kasich (R) of Ohio also have called for maintaining the expansion. In his letter to McCarthy, Governor Kasich noted that a recent study had found the lowest recorded level of uninsurance among low-income adults and a reduction in high-cost emergency department use. If changes must be made, Governor Kasich called for reducing the expansion eligibility limit from 138% of FPL to 100% of FPL, a change also supported by Arkansas Governor Asa Hutchinson (R).

CBO: More Than Half of 32 Million Losing Coverage Under Partial Repeal Would Be Medicaid Enrollees

The Congressional Budget Office (CBO) estimates that adopting the ACA partial repeal bill (H.R. 3762) passed by Congress and vetoed by President Obama in 2016, which would have eliminated the Medicaid expansion after a transition period, would cause a significant loss of insurance coverage and an increase in individual market premiums. After repeal of the Medicaid expansion and Marketplace subsidies, the estimated number of people losing coverage would jump to 32 million by 2026, 19 million of whom would lose Medicaid coverage. These estimates do not take into account the impact of any replacement provisions, and CBO is clear that estimates of the impact of future legislation will depend on proposal details.

Medicaid Expansion Improved Community Health Centers’ and Safety-Net Hospitals’ Finances, Reports Find

The Kaiser Family Foundation and HHS’s Assistant Secretary for Planning and Evaluation (ASPE) released reports on the ACA’s impact on community health centers and safety-net hospitals, respectively. The Kaiser report found that, following ACA implementation, the 24.3 million patients served by community health centers had higher insurance rates, and health centers in expansion states had higher total operating revenues and served 40% more patients compared to those in non-expansion states. ASPE’s expansive report found that the increase of insured patients in expansion states improved safety-net hospitals’ finances, while hospitals in non-expansion states typically experienced increased financial challenges as their patient mix remained steady.

Study Links Medicaid Expansion to Employment for People With Disabilities

People with disabilities in expansion states are significantly more likely to be employed compared with those in non-expansion states, according to a new study published in the American Journal of Public Health. In expansion states, 40% of individuals surveyed—community-living adults aged 18-64 reporting a disability—said they were not working because of their disability, compared to 48% in non-expansion states. The study’s lead author argues that the findings contradict suggestions by expansion opponents that expanding Medicaid discourages work.

Medicaid Expansion Increased Access to Substance Use Disorder Treatment

The uninsured share of substance use or mental health disorder hospitalizations in states that expanded Medicaid fell from 20% at the end of 2013 to 5% by mid-2015, according to HHS’s Assistant Secretary for Planning and Evaluation. The national uninsured share decreased from 22% at the end of 2013 to 14% by the end of 2014, the year the ACA’s major coverage provisions were implemented. The report notes that states with the highest rates of drug overdose deaths would see “dramatic” increases in their uninsured rates under ACA repeal. In West Virginia, New Hampshire and Kentucky, which had the three highest drug overdose death rates in 2015 and all of which adopted the Medicaid expansion, uninsurance would nearly or more than triple.


House Introduces New Medicaid Expansion Bill

State Representative Susan Concannon (R) introduced a bill, authored by the Kansas Hospital Association, to expand the State's Medicaid program up to 138% of FPL, which would extend Medicaid eligibility to about 150,000 Kansans. The proposed expansion program, called “Bridge to a Healthy Kansas,” would be implemented through a Section 1115 waiver and is similar to bills that failed to pass the Legislature in June 2016. Like previous bills, the bill includes a work referral requirement for some adults, but drops a requirement that some enrollees pay premiums. The bill was introduced following recent wins in the Legislature by pro-expansion Republicans and Democrats. Committee hearings on the bill will begin in February.


Medicaid Expansion Is Boosting State's Economy

Michigan's Medicaid expansion, which covers approximately 600,000 people, generated over 39,000 jobs in 2016, according to a new University of Michigan study published in the New England Journal of Medicine. The study also projects that economic activity associated with Medicaid expansion will yield approximately $145 million to $153 million per year in State revenue from income and sales tax from 2016 through 2021. In that same time frame, Michigan will save $235 million annually from reduced spending on services previously not covered under Medicaid but that now fall under the expansion, such as State mental health and correctional health programs. Combined, the study found that the additional State tax revenue and budget savings will fully offset the State costs of Medicaid expansion at least through 2021, the last year of the study period.

North Carolina

Medicaid Expansion Announced by Governor, but Temporarily Blocked  

In one of his first acts in office, Governor Roy Cooper (D) announced that he would seek approval to expand Medicaid and released a State Plan Amendment (SPA) for public comment. A federal judge later issued a 14-day restraining order preventing federal regulators from considering Governor Cooper's request for SPA approval after Republican State legislative leaders filed a lawsuit maintaining that the Governor cannot seek SPA approval due to a 2013 State law. Governor Cooper maintains that the law does not apply to this SPA and that the law infringes on the Governor’s "core executive functions." State and federal officials have filed motions asking a federal court to lift the restraining order.


Report Finds Medicaid Expansion Improves Health, Reduces Expenses

A report issued by the Ohio Department of Medicaid found that Medicaid expansion contributed to a decline in the uninsured rate for low-income Ohio adults from 32.8% in 2010 to 14.1% in 2014, the lowest uninsurance rate ever recorded in the State. Findings indicated that most Ohioans who gained coverage under Medicaid expansion were previously uninsured, and that over 40% of enrollees, citing better access to care, experienced a decline in unmet health needs under Medicaid expansion. The report was commissioned by the Ohio State Legislature and measured how expansion affected access to care, service utilization, health status, and financial burden. Following the Presidential election, the Ohio Governor's Office of Health Transformation has publically committed to maintaining Ohio's Medicaid expansion in its upcoming two-year budget plan.


Bill Introduced to Expand Medicaid Under Block Grant Funding

State Senator Richard Briggs (R) introduced a bill directing State Medicaid officials to submit a waiver application to CMS to expand Medicaid eligibility to those earning up to 138% of FPL, if the federal government converts Medicaid funding to a block grant model. Briggs was a member of the Legislature's 3-Star Healthy Task Force, which last summer proposed an expansion of Medicaid eligibility to military veterans and individuals with behavioral health conditions with incomes up to 138% of FPL.


Decision on Limited Medicaid Coverage Plan Delayed to New Administration

Earlier this month, the Obama Administration announced it would not issue a decision on the State's proposed limited Medicaid eligibility extension, opting instead to delay a decision until the Trump Administration. Utah has proposed extending Medicaid coverage to approximately 16,000 Utahns, predominantly those living in extreme poverty, including the chronically homeless and those involved in the criminal justice system.



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