State Update

States Move Ahead with Medicaid Expansion

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State legislatures across the country are continuing to debate Medicaid expansion under the Affordable Care Act (ACA). Below is a brief summary of policy updates in Arkansas, New Hampshire, Utah and Virginia.

Arkansas

With Gov. Mike Beebe’s (D-AR) approval of S.B. 111, Arkansas ensures that the private option will remain and more than 100,000 residents of Arkansas will be able to have health care, at least for another year. Specifically, S.B. 111 extends funding for the private option for one year.

The private option is Arkansas’ alternative to the expansion of state Medicaid rolls that was proposed under the ACA. The state obtained permission from the U.S. Department of Health and Human Services to use the federal Medicaid money that would have gone to state Medicaid expansion to subsidize private health insurance for people earning up to 133% of the federal poverty level. 

New Hampshire

On March 27, Gov. Maggie Hassan (D-NH) signed S.B. 413 into law. The law requires the state to develop the New Hampshire Health Protection Program to provide a coordinated strategy to access private insurance coverage for uninsured, low-income citizens with income up to 133% of the federal poverty level (FPL), using available, cost-effective health care coverage options for Medicaid newly eligible individuals at the earliest practicable date. The strategy must promote the improvement of overall health through access to private insurance coverage options and draw appropriate levels of federal funding available through a Medicaid Section 1115 demonstration waiver. 

“The bipartisan health care expansion plan will improve the health and financial well-being of more than 50,000 hard-working people who deserve the security of health insurance. By expanding access to health insurance, we will help reduce uncompensated care and cost-shifting on New Hampshire businesses, encourage cost-saving primary and preventive care and provide substance abuse and mental health treatment to thousands while injecting $2.5 billion in federal funds into our state’s economy,” said Gov. Hassan.

In New Hampshire, Medicaid covers dental care for children up to age 21, as well as disabled adults and pregnant women. New Hampshire’s Medicaid program pays for preventive care for children; however, for adults it only pays for emergency care, such as extractions. S.B. 413 would do nothing to change that. However, according to senior officials at the New Hampshire Department of Health and Human Services (DHHS) providing adult dental benefits under Medicaid is a wise way to expend health care dollars. Staff at DHHS are currently exploring ways to redeploy the savings accrued by expanding Medicaid and offer comprehensive adult dental benefits. 

Utah

Gov. Gary R. Herbert (R-UT) wants the federal government to place the money it would give Utah for Medicaid expansion into a block grant, allowing the state to administer its own program.

During this proposed three-year pilot program, the state would use the block grant funds to provide help to Utahns who make under $15,500 a year. Healthy Utah would provide assistance to pay for health insurance in private markets. The exact amount of assistance would depend on four factors:

 

  • Ability to work,
  • Household income,
  • Access to employer or family health insurance, and
  • Individual health care needs.

 

All participants in Healthy Utah would have to make co-payments to help pay for the cost of their care. In addition, parents with children on Medicaid would have the option to put their entire family on private insurance plans.

Although some initial meetings took place in March to begin the negotiations between the state and the U.S. Department of Health and Human Services, nothing formal has been drafted or agreed upon, according to staff in the governor’s office. However, the governor is scheduled to be in Washington, D.C., in mid-April.

Virginia

Gov. Terry McAuliffe (D-VA) has made expanding Medicaid eligibility to as many as 400,000 Virginians his top legislative priority. As a result of the Virginia General Assembly not reaching an agreement on Medicaid expansion during the regular session, Gov. McAuliffe called a special session. The governor stated that his “intention is for the [special] session to last for three weeks so the House and Senate can resolve outstanding budget issues and reach an agreement on closing the coverage gap.” The governor has spent the two weeks since the end of the regular session making appearances at health centers around the state to promote the benefits of Medicaid expansion. The special session began on March 24.

During a press conference held on March 24, Gov. McAuliffe announced his proposal to expand Medicaid under a pilot program that could end after two years without financial penalty to the state. However, there are some legislators in the state who would rather see Medicaid pulled from the budget discussion altogether; while others prefer to accept Medicaid expansion funds under a private option plan.

The Senate Finance Committee heard public testimony regarding Medicaid expansion on April 1, and a meeting of the Medicaid Innovation and Reform Commission (MIRC) will be held April 7 to further discuss potential ideas for Medicaid expansion in the state.