A total of 31 states
and the District of Columbia have expanded their Medicaid programs under the
Affordable Care Act since 2010. Below is a brief Medicaid expansion update for
the following states: Kansas, Kentucky, Indiana, Tennessee and Virginia.
On March 30, Gov. Sam
Brownback (R-KS) vetoed HB 2044. The bill would have
expanded Medicaid in the state in accordance with the Affordable Care Act.
Specifically, the bill
modified the eligibility requirements for the Kansas Medical Assistance
Program, on or after January 1, 2018, to include any nonpregnant adult under age
65 who is a U.S. citizen or legal resident and who has been a resident of Kansas
for at least 12 months, whose income does not exceed 133 percent of the federal
poverty level (FPL). The bill also required referral to workforce training
programs, created a health insurance coverage premium assistance program, and
required submission of a waiver request to the federal government.
In his veto message, the
Governor said, “I am vetoing this expansion of Obamacare because it fails to
serve the truly vulnerable before the able-bodied, lacks work requirements to
help able-bodied Kansans escape poverty, and burdens the state budget with
unrestrainable entitlement costs.”
On April 3, the full House
failed to override the Governor’s veto. The motion to pass the bill
notwithstanding the Governor’s veto failed by a vote of 81–44.
Seema Verma, the new Administrator
for the Centers for Medicare & Medicaid Services (CMS), is recusing herself
from the agency’s pending decision on Kentucky’s 1115 waiver, proposing a work
requirement for all able-bodied Medicaid recipients.
Specifically, the waiver
states, “To assist with employment, Kentucky HEALTH will require that all
able-bodied working age adult members without dependents participate in the
community engagement and employment initiative to maintain enrollment.
Engagement activities include volunteer work, employment, caretaking, job
training, or job search activities.”
The 1115 waiver request
notes that, “Children, pregnant women, individuals determined medically frail,
and adults who are the primary caregiver of a dependent, including a minor
child or a disabled adult dependent, are exempt from the community engagement
and employment initiative.”
Ms. Verma has helped
Kentucky develop a plan to overhaul its Medicaid program, and is therefore recusing
herself because of a conflict of interest.
Recall that former
President Barack Obama’s administration routinely denied requests by states to
incorporate work requirements into their Medicaid programs.
Kentucky’s proposal is
similar to Indiana’s Medicaid expansion proposal, which was designed by Ms.
Verma’s policy firm, Indianapolis-based Strategic Health Policy Solutions.
Kentucky’s expansion, like Indiana, would require all enrollees to make small
monthly contributions toward their coverage.
It is expected that Ms.
Verma will also recuse herself from Indiana’s pending waiver. The Indiana 1115 waiver would require a referral
to a work program.
Specifically, the state “seeks
to encourage participation in the Healthy
Indiana Plan (HIP) Gateway to Work program in order to connect members to gainful
employment, which not only improves physical and mental health, but the
individual’s overall financial stability and wellbeing. To this end, the
managed care entities will be required to develop member incentive programs
specific to promoting employment, including but not limited to rewarding
members for successful participation in the HIP Gateway to Work program through
the completion of available job training, work search, or educational activities
that will assist members in securing gainful employment.”
On April 5, HB 846 was withdrawn from
consideration in the Insurance and Banking Subcommittee of the Insurance and
Banking Committee by the bill’s sponsor, House Minority Leader Rep. Craig
Fitzhugh (D-TN). The bill would have authorized the governor to expand Medicaid
pursuant to the Affordable Care Act and to negotiate with the Centers for
Medicare and Medicaid Services to determine the terms of the expansion.
In a statement explaining
why the bill was pulled, Rep. Fitzhugh said, “We took the bill off notice with
the hopes it can be revived if and when the Subcommittee reconvenes at a date
later this year.”
On April 5, state lawmakers
reconvened for a one-day session to consider the governors vetoes and budget amendments. The House voted 66-34 to
reject the governor’s proposed budget amendment to allow him to expand Medicaid
on Oct. 1 if the opportunity remains under the Affordable Care Act.
Gov. Terry McAuliffe (D-VA)
released the following statement after state legislators blocked his budget
amendment on Medicaid expansion:
“By refusing to expand the
[Medicaid] program, we’ve forfeited $10.4 billion and we will continue to
forego $6.6 million every day we do not take action . . . Expanding Medicaid
will not just make Virginians healthier by extending coverage to nearly 400,000
people, it will also strengthen our economy. We would create up to 30,000 jobs,
save our budget $73 million annually, build a healthier workforce, and help
struggling rural community hospitals.”
ADEA will continue to
provide updates related to Medicaid expansion policy.
Section 1115 of the Social Security Act gives the Secretary of Health and Human
Services authority to approve experimental, pilot or demonstration projects
that promote the objectives of the Medicaid and Children’s Health Insurance
Program (CHIP) programs. Under this authority, the Secretary may waive certain
provisions of the Medicaid law to give states additional flexibility to design
and improve their programs.