Manatt on Medicaid: Monthly Expansion Recap

National News

Growth in Prescription Drug Spending Not Linked to Medicaid Expansion, Study Finds

Medicaid expansion was not likely a “major driving force” behind the record high drug spending growth in 2014, despite its association with an increase in the number of Medicaid drug prescriptions that year, according to a study published in Health Affairs. The study’s findings suggest that Medicaid expansion enrollees were prescribed drugs at the same rate as Medicaid enrollees in non-expansion states, but that these drugs were less expensive; hence, expansion was associated with a relative decrease in Medicaid drug spending per enrollee. The authors suggest that prescription drug cost-containment efforts may have limited drug spending growth in expansion states, noting that 19 expansion states but only nine non-expansion states have implemented pharmacy management initiatives.


Medicaid Expansion Spending Is $30 Million Over Original Budget Estimates

Alaska has spent $175 million on Medicaid expansion enrollees as of July 31, 2016, which is $30 million over original estimates, according to data from the State’s Department of Health and Social Services. The data also highlighted that nearly 20,400 individuals have enrolled in expansion, 36.7% of whom are between the ages of 19 and 34. Alaska expanded Medicaid in September 2015.


Task Force Proposes Medicaid Expansion Options

The Georgia Chamber of Commerce's healthcare task force released a report detailing three potential Medicaid expansion plans, all of which would require an 1115 Medicaid waiver. Each proposed expansion program would cover the minimum Medicaid benefit package allowable under federal law, require cost-sharing and premiums and establish health savings accounts for beneficiaries. The first option is a "partial expansion" to individuals earning up to 100% FPL; the second option is a full expansion for adults earning up to 138% of FPL; and the third option would enroll adults up to 100% of FPL into Medicaid and those with incomes between 100% and 138% of FPL into Marketplace plans paid for by Medicaid. In the past, CMS has allowed states to enroll Medicaid beneficiaries into Marketplace plans, but, it has ruled out partial expansion at the enhanced matching rate. Per 2014 legislation, any Medicaid expansion plan in Georgia is subject to legislative approval.


Nearly One-Third of Uninsured Kansans Would Qualify for Medicaid Expansion, Report Finds

An annual report from the Kansas Health Institute analyzing the nearly 302,000 uninsured in the State found that 31.9% would be eligible for Medicaid if the State took up Medicaid expansion, while 16.6% are currently eligible for Medicaid or CHIP, and 50% are eligible for subsidized coverage through Overall, the percentage of uninsured Kansans decreased from 12.3% to 10.5% between 2013 and 2014. Between 2009 and 2014, the percentage of Kansans enrolled in public insurance programs like Medicaid and the Children’s Health Insurance Program (CHIP) increased from 24.6% to 28.5%.


Medicaid Expansion Enrollees Report Increased Coverage and Access to Care, Improved Health

Enrollees in the Healthy Michigan Plan, the State's alternative Medicaid expansion, report having increased coverage, improved access to care and improved health status, according to a new survey conducted by the University of Michigan Institute for Healthcare Policy and Innovation. According to Modern Healthcare, 60% of surveyed enrollees reported not having coverage prior to enrolling in the Healthy Michigan Plan; 90% reported that coverage is affordable; and 86% said that their ability to pay medical bills has improved since enrollment. The results of the survey were submitted to CMS on September 15.

New Jersey

Nearly 567,000 Covered Due to Medicaid Expansion

Nearly 567,000 residents have gained or maintained coverage under Medicaid expansion, according to NJ Family Care’s (the State’s Medicaid program) 2015 Annual Report. Governor Chris Christie (R) spoke to the success of the expansion, noting that of those who gained or maintained coverage due to expansion, 59% are newly eligible adults, 23% maintained eligibility due to expansion, and 18% were previously eligible but not enrolled. The report also found that the decision to expand Medicaid helped lower the State’s uninsured rate from 12% in 2013 to 7% in 2015, decreased the State’s share of overall Medicaid expenditures from 45% in 2014 to 39% in 2015, and lowered average costs per beneficiary from $9,690 in 2014 to $8,940.


CMS Denies Medicaid Waiver Request to Charge Premiums Under Penalty of Disenrollment

CMS has denied Ohio's 1115 Medicaid waiver request, citing concerns about the State’s proposal to charge Medicaid enrollees—with the exception of pregnant women—premiums under penalty of disenrollment, which Ohio officials estimated in their waiver request would lead to a loss of coverage for more than 125,000 enrollees per year. The State has not indicated that the Medicaid expansion program will be impacted by the denial, nor has it announced whether it will continue to pursue the 1115 waiver with CMS. CMS wrote in a letter to the State that the policy "would undermine access to coverage and the affordability of care, and [does] not support the objectives of the Medicaid program." To date, CMS has not approved any 1115 waiver that requires monthly contributions as a condition of ongoing eligibility.



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