Medicaid Expansion Round-Up

15 May Medicaid Expansion Round-Up

During the 2016 Presidential campaign and shortly after assuming office, President Trump was adamant about repealing the ACA’s provisions for Medicaid expansion. In fact, President Trump and the administrator of The Centers for Medicare and Medicaid Services (CMS), Seema Verma, are now considering waivers to the Medicaid program that the previous administration rejected. Despite the Trump administration’s unsuccessful efforts to reform Medicaid on the federal level, a handful of states are making attempts to expand their programs. Here is a summary of states in various stages of expansion discussions.

States Considering Medicaid Expansion

Nebraska: Over the last six years, any efforts to expand Nebraska’s Medicaid program have failed due to Republican leadership. Republican Governors, Pete Ricketts and his predecessor Dave Heineman both argued that the state couldn’t afford to expand Medicaid. Additionally, they believe that expanding Medicaid would favor able-bodied citizens as opposed to low-income residents, for whom the program was designed.

However, that may all change this November at the voting booths. Currently, there are several healthcare associations and advocacy groups in the process of collecting signatures from citizens to secure a proposal under the Insure the Good Life Petition. Having seen the success of Maine’s ballot initiative, supporters in Nebraska are gaining confidence that they will yield a similar result. In order for the proposal to be included on the ballot, a total of 85,000 signatures from registered voters are required by July 6, 2018. According to Insure the Good Life organizers, residents have been receptive to the idea of expanding Medicaid. 

Idaho: Despite resistance from the Republican-leaning legislature, Idaho activists are seeking to expand their Medicaid program to 78,000 residents under the ACA with a ballot initiative. Expanding the program would help to cover Idahoans who fall into a coverage gap because they make too much money to be eligible for Medicaid but not enough to receive subsidized health insurance in the exchange.

In order to get on the November 6th ballot, advocacy groups needed to secure a minimum of 56,192 signatures from 18 districts across the state by May 1, 2018. The advocacy groups submitted the signatures before the deadline and claim they have the required threshold needed to get a place on November’s ballot.

Beginning January 1st, the group Reclaim Idaho went to work, securing support from voters. As of April 30th, according to the activist group, they have accumulated enough signatures to satisfy the petition requirements. At this point, the signatures will need to be verified by county clerks before June 30th, in order for the expansion proposal to be voted on.

While hopes are high among supporters, implementation of expansion will fall on the governor and state legislators; moreover, they have the power to overturn voter-passed initiatives. Republican candidate, Rep. Raul Labrador will oppose the expansion initiative if he is elected. According to Labrador, “ I think that they need to be informed about what Medicaid expansion would do for the state. If you look at every single state that has expanded Medicaid, they’re spending more money than they expected to spend … and that’s taking away money from all the other needs.”

Utah: Despite the available federal funding and the states Republican Governor, Gary Herbert’s (R – UT) support of Medicaid expansion, there has been enough resistance from the state legislature in Utah to prevent any expansion momentum. Supporters of expanding Medicaid in Utah pushed back by passing a ballot initiative similar to Maine’s.

In addition, Governor Herbert also signed the HB472 bill. The bill seeks permission from the federal government to expand his states Medicaid program to 100% of the federal poverty level (FPL) while also implementing work requirements in order to eliminate the coverage gap. Expanding that states program to 100% of the FPL would extend coverage to 72,000 residents by 2020 rather than 150,000 under 138% FPL. If the bill passes, Utah’s out of pocket expenses would be far less than if their program expanded to 138% FPL.

Arkansas submitted a similar plan that would have capped eligibility at poverty level instead of 138% of the FPL. CMS did not approve the request and it is unlikely that CMS will back the governor’s bill since the federal government has only approved these types of requests under the condition that states expand to 138% of the FPL.

While the governor’s administration would like to receive approval for the bill, Utah voters will also have an opportunity to weigh in at the ballot boxes in November to fully expand Medicaid to the 138% FPL.

Virginia: In February, The Virginia House of Delegates voted and approved a budget adopting ACA Medicaid expansion in conjunction with work requirements for enrollees. However, Virginia’s Senate budget did not include provisions for expansion. Due to the split support for Medicaid expansion, the Virginia legislature was unable to finalize a budget. As a result, the implementation of Medicaid expansion and Virginia’s FY 2019 budget are currently deadlocked. It has been nearly two months since Virginia’s General Assembly adjourned without consensus.

On May 14th, the Senate met for a special session to discuss a spending plan and the Senate Finance Committee will continue work on the budget today. The entire Senate will reconvene on May 22. In order for Virginia to expand its Medicaid program, there will need to be a majority vote in both the House and Senate. If Virginia legislators cannot come to an agreement by June 30th, the state could face its first government shutdown. 

Maine Has Adopted Medicaid Expansion But Is In Legislative Deadlock

Maine’s Medicaid program, MainCare, was approved for expansion last November through a ballot initiative. Voters supported the expansion by 59%. However, for 80,000 low-income residents who would have been eligible for coverage, the state missed the state plan amendment submission deadline to CMS (April 3, 2018). The legislature is currently facing a deadlock due to Governor LePage’s (R) resistance to expansion.

After the vote, the governor stated, “this fiscally irresponsible Medicaid expansion will be ruinous to Maine’s budget.”

Under the law, it is estimated that Maine would spend $55,000,000 annually on the program and the federal government would cover at least 90% of the cost of MainCare’s new enrollees. LePage argues that the cost of the expansion is double the amount estimated by the state legislature and refuses to implement the plan unless his conditions are met.

LePage’s conditions include:

  • That taxes will not increase
  • Stabilization money funds won’t be used
  • The funding mechanism will be ongoing
  • Wait lists for the disabled and elderly are satisfied prior to Medicaid eligibility expansion.

As a result of Governor LePage’s resistance, Maine Equal Justice Partners (MEJP) has filed a lawsuit against DHHS for failure to act. MEJP argues that the administration is denying residents coverage that is mandated by law. They fear that an estimated 70,000 low-income residents seeking coverage will not be able to enroll by the next deadline, July 2, 2018. Maine’s State Attorney General, Janet Mills, declined to represent the governor in the case. However, she did approve LePage’s request to seek outside counsel for representation in the case.

The landscape of Medicaid is evolving as reformists submit waivers and implement work requirements. At the same time, Republican leadership across the country is resisting Medicaid expansion, believing that it goes against the programs original intent. Despite the GOP’s resistance, there is a tremendous amount of activity amongst expansion advocates to expand their state’s Medicaid programs. By way of ballot initiatives, voters are stepping out in front of their legislatures to voice their support for expansion at the polls this fall.