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WY-Wyoming Medicaid expansion budget amendment ruled unconstitutional

MM Curator summary

[MM Curator Summary]: The move to approve expansion in the legislature has now failed in both the House and the Senate.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

CHEYENNE — The full Wyoming Senate wasn’t able to vote on a Medicaid expansion amendment to the budget bill Wednesday night after the Rules Committee declared it unconstitutional.

Medicaid expansion has been a long-term effort by advocates such as Better Wyoming and the Healthy Wyoming Coalition, which made arguments in support of passing legislation so 24,000 residents could gain access to medical insurance. The groups said it also would encourage economic growth and help businesses retain employees.

Although there has been considerable support shown across the state, the Senate entertaining the amendment was one of the last opportunities for expansion promoters this year.

House Bill 20, the “Medical treatment opportunity act,” was never introduced in the House of Representatives because House Speaker Eric Barlow, R-Gillette, said there weren’t enough votes for it to meet the two-thirds threshold required for non-budget bills during a budget session.

But Sen. Cale Case, R-Lander, followed through on his intention to bring it to the Senate budget discussions. He is co-chair of the Joint Revenue Interim Committee, which sponsored HB 20.

“This expansion is pro-hospitals,” Case told fellow legislators as he introduced the amendment. “It creates jobs. It supports those very people that we care about, the people that wait on your table or clean your hotel room. These are working people. These aren’t unemployed people.”

As soon as the amendment was introduced, however, Majority Floor Leader Sen. Ogden Driskill, R-Devils Tower, asked Case to withdraw it or adhere to a Senate Rules Committee review.

The proposal was sent to the Rules Committee, where it was deemed unconstitutional by a 3-2 vote, since it wasn’t an ordinary expenditure of the Legislature.

I see nothing in here that has anything to do with appropriations,” Driskill said. “And it is a bill.”

This was one of the last budget amendments in a long line of them considered throughout the day Wednesday, spanning from education cuts to appropriations for suicide prevention.

Sen. Bill Landen, R-Casper, was successful in receiving votes for the first addition to the budget, which was $25,000 for the purpose of hosting a statewide conference on suicide by first responders, and developing a plan to address the issue.

Health care was among other major discussions. An appropriation of $3.2 million was made by the Senate for developmental disability agency providers, as well as requirements laid out for the Department of Health to submit a supplemental budget request for the fiscal year 2024 for the continued operation of the Wyoming home services care program.

 
 

Clipped from: https://www.thesheridanpress.com/news/regional-news/wyoming-medicaid-expansion-budget-amendment-ruled-unconstitutional/article_8c01869c-9594-11ec-a6e8-8fbb38190d7a.html

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KS- Long-promised Medicaid Expansion bill introduced in Kansas legislature

MM Curator summary

[MM Curator Summary]: The KS governor facing re-election is making the normal expansion promises: “free” federal money, jobs and saving rural hospitals.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

FILE – The Kansas Statehouse stands against the sky as the sun sets in the distance Monday, April 27, 2020, in Topeka, Kan.(Charlie Riedel | AP)

TOPEKA, Kan. (WIBW) – Governor Laura Kelly is hoping to make good on her 2018 campaign promise to expand Medicaid with new legislation introduced on Wednesday.

Kansas Governor Laura Kelly says on Wednesday, Feb. 9, she announced legislation to expand Medicaid – KanCare – to provide over 150,000 Kansans with access to affordable healthcare.

Gov. Kelly said the move would also create over 23,000 new jobs to strengthen the state’s economy.

“Expanding Medicaid so that thousands of hard-working Kansans have access to affordable health care would boost the Kansas economy,” Kelly said. “Expansion would inject billions of dollars into our state, create thousands of jobs, help retain our healthcare workers in Kansas —and help rural hospitals’ bottom lines. It’s time to work together to deliver for Kansans and get this done once and for all.”

Under the proposed bill, Medicaid would expand to cover Kansans who earn up to the full 138% of the Federal Poverty Level starting on Jan. 1, 2023.

Gov. Kelly said about 90% of the expansion would be paid by the federal government.

Furthermore, Kelly said if Medicaid is expanded, Kansas is poised to get an additional $370 million over the next eight fiscal quarters for the current enrollees. She said that is a total of $68.5 million in State General Fund savings in the Fiscal Year 2023 alone, which will be reallocated for a one-time investment in housing, childcare and workforce development.

A 2022 statewide survey found 78% of Kansans support Medicaid expansion to allow for more residents to qualify for coverage.

“The list of reasons to expand Medicaid grows with every year we refuse to do so,” said Senate Democratic Leader Dinah Sykes. “This wildly popular policy will ensure we have a healthy workforce, create jobs, and attract businesses. More importantly, it will allow our fellow Kansans to flourish and participate fully in our state, which brings prosperity for all of us. The first best time to expand Medicaid was in 2014. The next best time is now.”

Kelly said this is not only the right thing to do for Kansas, but it is incredibly popular among all political parties.

“Expanding Medicaid is enormously popular among Kansas and addresses many issues facing the state. First and foremost, it is a pro-business, pro-growth policy,” said House Democratic Leader Tom Sawyer. “Throughout the legislative session, people repeatedly ask what we can do to keep our college graduates in the state and bring in outside business investment. Medicaid expansion is a clear solution with bipartisan voter support. It’s past time to embrace this common-sense policy.”

According to the Governor, expanding Medicaid in the Sunflower State would boost the economy by:

  • Providing affordable health insurance to hundreds of thousands of Kansans
  • Stimulate the economy for rural, suburban, and urban communities alike
  • Create tens of thousands of new jobs
  • Inject billions of dollars in increased economic output
  • Retain health care jobs in Kansas

The bill would require the Secretary of Health and Environment to gather data from applicants about employment history through the Medicaid application. Unemployed or underemployed Kansans will be referred to the Department of Commerce or Department of Children and Family Services to help the applicant find job opportunities.

In 2021, a Medicaid expansion amendment to SB 238, which died on general orders on May 21. A day before the bill died, Gov. Kelly vetoed SB 29 which would have provided short-term health plans because a solution to the problem fixed by the bill would have been to expand Medicaid instead.

In September she sent a letter to Congressional leadership to again urge them to pass Medicaid expansion legislation.

In January, House Democrats said they introduced a Medicaid expansion amendment to the Kansas Constitution, as well as one to legalize marijuana recreationally and medicinally. In February 2021, Kelly even proposed Medicad expansion be funded by the legalization of marijuana.

Medicaid expansion was a promise Kelly ran on in her campaign for Governor in 2018.

Clipped from: https://www.kwch.com/2022/02/10/long-promised-medicaid-expansion-bill-introduced-kansas-legislature/

 
 

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SD – Senate rejects Medicaid expansion, leaving it to election

MM Curator summary

[MM Curator Summary]: State reps voted naye on expansion by a 2 to 1 margin.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

PIERRE, S.D. (AP) — A proposal to expand Medicaid health coverage eligibility was defeated in the South Dakota Senate Tuesday, leaving the decision to voters in the November election.

Republican Sen. Wayne Steinhauer had brought a proposal to the Legislature to make Medicaid, a federal-state health insurance program for low-income people, available to people who live below 133% of the federal poverty level. That is currently about $17,000 annually for an individual or $35,000 for a family of four.

“This thing is about people,” he said in an effort to counter arguments from his fellow Republicans that it would grow the size of government and drain money from elementary and high schools.

The Republican-controlled Senate rejected his bill on a 12 to 23 vote.

But a campaign backed by South Dakota’s major health care systems is trying to get voters to pass a constitutional amendment to expand Medicaid eligibility on the November ballot.

“It’s clear that the only path to expanding Medicaid in South Dakota is by letting the people vote on it directly,” said Zach Marcus, the manager for the campaign, in a statement.

He asserted that the proposal would allow 42,500 more people to access health care coverage and bring $1.3 billion in federal money to the state.

 
 

Clipped from: https://www.westport-news.com/news/article/SD-Senate-rejects-Medicaid-expansion-leaving-it-16921734.php

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NC- Key NC Republican lawmakers weighing Medicaid expansion vote before November

MM Curator summary

[MM Curator Summary]: The committee looking at expansion will not release its report until after the legislative session, but will release it before the gubernatorial election.

 
 

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

By Travis Fain, WRAL statehouse reporter

Key Republican leaders on Tuesday said to watch for an up-or-down vote on a potential Medicaid expansion deal before the November elections.

That doesn’t mean North Carolina, one of 12 U.S. states that hasn’t expanded Medicaid, will take the leap more than a decade after federal funding became available for the expanded health insurance program. But the prospects may be better than ever after years during which the proposal was a nonstarter in the Republican-controlled General Assembly.

Medicaid expansion would add hundreds of thousands of people, many of them the working poor, to the taxpayer-funded health insurance program that currently serves roughly 2 million people in North Carolina, most of them children, pregnant women, seniors citizens and people with disabilities.

Democrats have advocated for the expansion in an effort to close a health insurance coverage gap. Republicans, however, have long expressed concerns about how much it would cost taxpayers.

A joint House-Senate committee studying the issue is scheduled to hold its first meeting Friday. The committee may submit an expansion plan to the full General Assembly later this year.

“It depends what the substance of the measure is, but I think there’s a pathway,” Senate leader

Phil Berger
said Tuesday, adding that any vote would likely come before the November elections.

State Rep. Donny Lambeth , the committee’s co-chair and a long-time proponent for some sort of expansion plan, said Tuesday that one of the first things the committee will do is ask to push back its timetable.

The state budget, which created the committee, called on the group to present its findings before the 2022 legislative session begins. Lambeth, R-Forsyth, said it probably will take “into the summer and fall” for the group to complete its work.

Lambeth also said he’d like whatever the committee comes up with to come before the full General Assembly before the November elections, with implementation of any expansion approved in January.

“I think it’s possible for January,” Lambeth said. “That’s my goal.”

Democrats, including Gov. Roy Cooper, have pushed expansion for years, and at times there has been Republican support at the statehouse. Lambeth helped lead an effort in the North Carolina House to pass a compromise version that would have included work requirements for recipients. The plan didn’t have enough support in the state Senate, though, and it fell apart after the courts struck down work requirements.

Last year Senate Republicans seemed to be on board, but there wasn’t enough support in the House. A new enticement from the federal government—an extra $1.7 billion or more from the federal government for states that expand now—has helped boost support.

What a successful proposal would look like this year remains to be seen. Neal Inman, the chief of staff for Speaker of the House Tim Moore , said last week that there are “no predetermined outcomes” for the study committee, and any plan would have to overcome Republican concerns that it would put too many people on government health insurance.

Sen. Jim Burgin , R-Harnett, noted during a separate health committee meeting Tuesday that adding several hundred thousand people to the state’s Medicaid rolls would mean a third of the state’s population relies on Medicaid.

“Is a third of our population on Medicaid going to be sustainable in the long term?” he said.

Clipped from: https://www.wral.com/key-nc-republican-lawmakers-weighing-medicaid-expansion-vote-before-november/20140451/

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MO- Missouri looks at changing Medicaid funding

MM Curator summary

[MM Curator Summary]: Legislators concerned over the budget impact of Medicaid expansion move to create the ability to fund the expansion year by year.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Missouri looks at changing Medicaid funding

JEFFERSON CITY, Mo. – A House committee on Monday approved a proposed constitutional amendment that would change how Medicaid is funded in Missouri.

The Republican-backed proposed amendment comes after 53% of Missouri voters approved a constitutional amendment in 2020 to expand Medicaid funding, after the GOP-led Legislature for years refused to do so.

And a Missouri Supreme Court ruling last July forced the Legislature to fund the expansion, making thousands more state residents eligible.

On Monday, a House budget panel advanced the proposed amendment to the full house, the St. Louis Post-Dispatch reported.

If approved, the proposed constitutional change would give the Legislature the power to make annual appropriations for Medicaid, meaning lawmakers could choose not to fund the expansion.

House Budget Committee Chairman Rep. Cody Smith, R-Carthage, said the amendment would not necessarily mean all expansion costs would be cut. He argued it would allow lawmakers more flexibility to manage Medicaid spending.

Democrats said the proposal is another effort by Republicans to hurt poor people who need health coverage.

The proposal also includes a requirement for Medicaid recipients to work or perform community engagement.

 
 

Clipped from: https://journalrecord.com/2022/02/08/missouri-looks-at-changing-medicaid-funding/

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Medicaid expansion to get another crack in Wyoming after two defeats in 2021

MM Curator summary

[MM Curator Summary]: About 25,000 people would be added to the rolls if the measure is passed this time.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

(Shutterstock)

CASPER, Wyo. — Another attempt at Medicaid expansion in Wyoming has been proposed for the legislature’s consideration during its upcoming budget session. The Wyoming Legislature’s Joint Revenue Committee is sponsoring House Bill 20, known as the Medical Treatment Opportunity Act.

Medicaid expansion was previously proposed for the legislature’s consideration during its fall 2021 special session. That special session was primarily focused on responding to COVID-19 vaccine-related mandates and the Wyoming Senate voted 8-21 against introducing the Medicaid expansion bill during that session. Medicaid expansion was also proposed for consideration during the 2021 general session and passed in the House of Representatives on a vote of 32-28 but stalled out on a 2-3 vote in the Senate Labor, Health and Social Services Committee

Sen. Cale Case (Fremont County), who is Chair of the Senate Revenue Committee, argued in favor of Medicaid expansion during the October 2021 special session, saying that expanding Medicaid could benefit about 25,000 people in the state.

“They are people that serve you breakfast, clean your hotel rooms,” Case said. “They have children and this would be a great thing for them.”

A poll conducted by New Bridge Strategy in 2021 found that 66% of Wyoming’s registered voters support expanding Medicaid. That included 98% of Democrats in the state, 64% of Independents and 58% of Republicans.

The Medical Treatment Opportunity Act would direct the Wyoming Department of Health, the state’s insurance commissioner and the governor to negotiate with the Centers for Medicare and Medicaid Services (CMS) to amend the state’s Medicaid plan and expand eligibility.

Under the 2010 Affordable Care Act, 90% of the cost of expansion would be paid for by the federal government and Wyoming would pay 10%. The Wyoming Department of Health estimates expanding coverage would cover an estimated 24,000 (between 13,000 and 38,000) residents and net the state $34 million in General Fund savings over the next biennium.

The group Healthy Wyoming held vigils across the state in September 2021 to raise awareness about projected savings for the state under expansion and to share stories of people who have suffered and died without health care.

The Casper contingent met at the Nicolaysen Art Museum on September 17 to hear from health care providers, legislators, and people directly affected by the issue. 

“This issue is a matter of life or death,” said Healthy Wyoming advocate Andrew Schneider in his remarks. He said people who can’t afford to go to the doctor allow chronic conditions, including mental illness, to “linger and worsen.” They also skip cancer screenings and other preventative measures and can’t budget for both prescriptions and food.

Linda Jones spoke about her friend and neighbor Earl, who died three years ago. She said Earl worked a steady job at Walmart until he slipped on the ice and injured his knee, and lost his job while recovering.

Without insurance, he was unable to achieve a full recovery, became afflicted with gout, and sold a cherished Camero to pay bills. His health declined rapidly and he was eventually found dead in his home.

“It was a difficult thing to watch another person be in so much pain and not know how to help,” Jones said. “At the time, we didn’t think there was anything that could be done about Earl not being able to see a doctor. … Now I know that if our state had expanded Medicaid, Earl could have gotten the health care he needed.”

“He wanted to get better; he wanted to work to provide for himself.”

Critics have cited concerns that expansion has led to significant cost overruns and decreased profit margins for hospitals in other states. They also worry that the federal government could change its match rates, leaving Wyoming “on the hook” for a greater percentage of costs.

 
 

Clipped from: https://oilcity.news/community/legislature-community/2022/01/24/medicaid-expansion-to-get-another-crack-in-wyoming-after-two-defeats-in-2021/

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MO- Funding still pending for Medicaid expansion

MM Curator summary

[MM Curator Summary]: After being forced to change the eligibility requirements to expand Medicaid, the state legislature has not reached agreement on actually funding the expansion program.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Sen. Dan Hegeman, R-Cosby, is seen in a file photo. Hegeman said Medicaid will be funded for this year, but there are some concerns about the continued impact of funding the expanded coverage. 

File photo | News-Press NOW

2022 funding for Medicaid expansion still needs to be finalized in the state of Missouri.

State Sen. Dan Hegeman, R-Cosby, who serves as the Senate’s budget chairman, said Gov. Mike Parson came up with a supplemental budget that needs to be finalized before March which includes federal dollars for education, expansion of Medicaid and state employee pay raises.

Hegeman said money in the budget is there to fund Medicaid, but there are concerns regarding funding the expanded coverage in years to come.

“Right now we have the money to be able to do the expansion, it’s the long term that people are concerned whether we will continue to have the money to do that, especially if the federal government ever changes the Medicaid program where we have to come up with a larger portion for the state of Missouri,” Hegeman said.

Medicaid expansion was approved by the citizens of Missouri in the November 2020 election. Since then, legislators have been engaged in a lengthy battle in regards to funding.

Hegeman said the general revenue budget is strong and that is why the state is looking at the employee pay raise to establish a base salary of $15 an hour and have a 5.5% increase in pay.

Another bill in circulation is House Joint Resolution 117 sponsored by State Rep. Cody Smith, R-Carthage. The bill, which had a hearing on Jan. 19, would require individuals below 138% of the poverty line to be referred to as the “Medicaid expansion population” by appropriation. If an appropriation specifically naming this population is not made for the fiscal year, the population would not be eligible for HealthNet services for that fiscal year. The bill currently is not on the House’s calendar.

The bill also would compel this population to comply with work and community engagement requirements where they would have to work or be involved in community engagement for 80 hours a week.

 
 

Clipped from: https://www.newspressnow.com/news/local_news/government/funding-still-pending-for-medicaid-expansion/article_5144f6e2-7d66-11ec-b5c4-f332668a05d9.html

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Missouri Medicaid expansion: long waits for applicants

MM Curator summary

[MM Curator Summary]: Long delays in application processing may be behind the lower-than-expected uptake of expansion in the Show Me State.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

By Jeanne Kuang

Updated January 25, 2022 11:03 AM

In this October file photo from Mountain View, Mo., Carolyn Hayes, 55, answers questions from Good Samaritan Care Clinic volunteer Vicky Medley, a retired Department of Social Services employee, to fill out an application for Missouri’s expanded Medicaid program. Outreach work to get low-income adults enrolled has fallen to grassroots organizations and clinics serving the poor. Jeanne Kuang/The Kansas City Star

JEFFERSON CITY

As soon as the Missouri Supreme Court ruled last July that Medicaid expansion must go forward, Amanda Leach applied.

The 29-year-old southwest Missouri woman and her husband had both been uninsured for years, making too little to afford private insurance, but too much to qualify for Medicaid under the old rules. The new eligibility guidelines, approved by Missouri voters in August 2020 after years of opposition from lawmakers, allowed adults in a family of five to qualify if they earned up to $42,800 a year.

Leach, who has three children, was eager to get coverage for the corticosteroids used to treat her asthma. She could only afford refills during the months she qualified for Medicaid while pregnant. When she showed up at an urgent care center with COVID last July, struggling to breathe, she refused to be hospitalized for lack of insurance.

She ended up waiting nearly four months for Medicaid.

“I couldn’t even tell you how many hours I spent on the phone” checking the status of her application, she said. The state lost her proof of income twice during that time.

Missouri didn’t start officially processing applications for expanded Medicaid until October, partially explaining the delay.

But four months into the program’s official start, long waits like the one Leach faced are increasingly common.

Last month it took the Department of Social Services an average of 70 days to process a Medicaid application, a nearly ninefold increase from a year ago and well past the 45-day maximum set by federal law.

The department says it faces staff shortages as applications pile up. The division that processes applications saw a 20% turnover last year and a more than 70% decline in job candidates, DSS spokeswoman Heather Dolce said in an email. DSS is paying overtime and shifting workers’ assignments to keep up with “a large volume of applications and calls at this time,” Dolce said.

This month, officials told the House Budget Committee, nearly 70,000 Missourians who applied for expanded Medicaid were waiting to find out if they had been approved – more than have been enrolled.

The delays are the latest hurdle in what advocates have criticized as a slow and rocky launch of the expansion.

“Is it going at the appropriate pace? The answer is emphatically no,” said Sheldon Weisgrau, vice president of health policy for the Missouri Foundation for Health. “It is going much slower than anybody anticipated.”

Voters approved the expansion in a constitutional amendment in August 2020. But after lawmakers refused to fund it, Gov. Mike Parson nixed the planned July 1 launch last year. A judge ordered the state to expand the program anyway, but Parson’s administration delayed the start date to October to prepare for the influx of applicants. Full funding for the expansion, including the cost of 55 new employees to determine applicants’ eligibility, still hasn’t been approved by the legislature.

Since October, Missouri has enrolled more than 58,000 newly eligible adults in the program.

That’s well short of signups in Oklahoma, which also expanded Medicaid last year after voter approval. There, the state opened up applications before the planned start date and had 113,000 enrolled in the first month.

It’s also short of Missouri’s own projections. As it prepared to implement the program last year, Parson’s administration estimated that in the fourth month of expansion, Missouri would be covering more than 192,000.

‘Real outreach’

Lack of awareness is one factor hampering full enrollment of the roughly 275,000 low-income Missourians the state expected to gain coverage under the expansion, according to health advocates.

The delay and subsequent court case likely confused people who may be eligible, they say, making local, grassroots outreach efforts particularly crucial.

DSS said the department has updated its website, social media platforms and email newsletters with information about the expansion. But advocates say the agency has failed to reach much of the low-income population that could qualify.

“There hasn’t been any real outreach to speak for from the state,” said Timothy McBride, a health economist at Washington University in St. Louis and former chair of the state’s Medicaid oversight committee.

Instead, much of that work is dependent on low-income clinics or other organizations that serve the poor.

Rates of enrollment appear to vary across the state, according to DSS data from the first three months of expansion that Washington University researchers have analyzed.

In some counties, as many as six or seven percent of the low-income adult population that could qualify have been enrolled. The two counties with the state’s highest rates of uninsured adults are lagging behind. McDonald County has only enrolled 3.3% of its low-income adult population, while Scotland County has enrolled 2.7% — just 34 people.

“My hunch is the variation’s reflective of how well people on the ground are doing in enrolling people,” McBride said.

At Scotland County Hospital
in northeast Missouri,
a staff member was trained to help patients sign up, in preparation for the expansion. But hospital officials said worker shortages have forced them to send patients to the nearest DSS office.


 

“We don’t have the horses to pull the cart when it comes to just medical care,” said CEO Randy Tobler, an advocate of expansion for the benefits it could bring to his patients and to struggling rural hospitals. “We’ve not been able to do outreach … Frankly, we’ve just put that on the back burner.”

‘Huge barrier’

Advocates say there are ways the state could more easily enroll large numbers of people who are now eligible for health care: by finding Missourians who already receive other social services.

Leach, for example, is no stranger to DSS, which checks her and husband’s income regularly because their three children have always qualified for Medicaid.

States like Louisiana have used income data from the Supplemental Nutrition Assistance Program, or food stamps, to enroll eligible residents without requiring their application.

In Missouri, that hasn’t happened. DSS “can only determine adult expansion eligibility if an application for healthcare coverage is received or an individual is found to be ineligible for another Medicaid category,” Dolce said.

The state is automatically moving some health care recipients from other programs to the expanded Medicaid. It has a financial incentive to do so. The state pays only 10% of the costs for recipients in the expanded program, compared with about 35% for other Medicaid beneficiaries.

Of those currently enrolled, Family Support Division director Kim Evans told lawmakers this month, about 27,000 are women who had been receiving family planning coverage under a separate state program.

The recent delays in application processing have created a dilemma for advocates who are trying to get more people enrolled, Weisgrau said.

“Ideally, you want to be out there waving the flag for this and beating the drum and letting people know what’s available,” Weisgrau said. “But when all you’re doing is putting people into a queue that takes more than two months for them to find out if they’re eligible, it creates a real problem and a lot of those people get frustrated.”

Applicants who haven’t heard back might give up on an application, or apply more than once, adding to the backlogs, Weisgrau said.

In October, a slip and fall landed Leach in the hospital with a broken calf bone and crushed ankle. By the time the bill arrived about a month later, she was finally approved for coverage. But the cost of her ER visit and surgery still caused a brief panic. Without Medicaid, she would have owed the equivalent of 18 months of mortgage payments.

She works in homeless outreach at a Springfield church, The Connecting Grounds, where she and a colleague have helped more than 100 people apply.

Even with use of the church’s computers, the application process and wait times can be challenging for people living in poverty who don’t have reliable Internet, phone service or even a permanent address, she said.

If they get locked out of the state’s online application they have to mail or fax their proof of income. If there is a question about their application they can’t always be reached.

“When I was trying to get through, the shortest wait time I had (on the phone) was three and a half hours,” Leach said.

“You don’t have the time to do that if you’re buying (cell phone plans) by the minute. And they can’t get hold of you about stuff when you never know if your phone is going to be on or if you’re going to have cell service. So that has been a very huge barrier for a lot of our folks.”

This story was originally published January 25, 2022 10:34 AM.

 
 

Clipped from: https://www.kansascity.com/news/politics-government/article257658623.html

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Oklahoma’s Medicaid costs surging

MM Curator summary

[MM Curator Summary]: Medicaid expansion costs have begun to put serious financial strain on the state appropriations process.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Ray Carter | January 25, 2022

Ray Carter

Due to passage of State Question 802, Oklahoma’s Medicaid program was expanded starting last July to include many able-bodied adults. The expansion, which was authorized by the federal Affordable Care Act (better known as “Obamacare”), was touted as a way to expand health services with little real cost to state governments because a high rate of federal matching funds was provided.

But during an Oklahoma Health Care Authority (OHCA) budget presentation to state lawmakers this week, OHCA officials listed “sustainable funding for expansion population” as one of the major challenges facing the agency.

“We still have to work on a sustainable funding mechanism for expansion,” Kevin Corbett, CEO of the Oklahoma Health Care Authority, told members of the House Appropriations and Budget Committee.

Last year, lawmakers had to provide an additional $164 million in state appropriations just for the Medicaid expansion population. That money came mostly from an increase in the Supplemental Hospital Offset Payment Program (SHOPP) fee assessed on some hospitals’ revenue.

However, hospital officials have since announced they no longer want to pay the SHOPP fee, even though hospital officials previously endorsed both the creation of SHOPP and the expansion of Medicaid. Hospital officials instead urged lawmakers to divert other tax collections away from other uses.

In the first six months, officials have added roughly 200,000 individuals to Medicaid as a result of expansion, although Corbett said only 160,000 represent true new enrollees since the remainder previously had coverage through other government programs.

The added costs created by expansion come amidst a dramatic surge in the overall cost of Oklahoma’s Medicaid program.

“You can see we’ve had a growth with regards to this program,” Corbett said. “If you look at just where we were in 2017 and where we are for fiscal ’22, it rises from a $5.5 billion budget, or organization, to an $8 billion budget, almost 46-, 47-percent increase, largely due to enrollment increases as well as cost or utilization of services.”

Most of the increased cost has been borne by the federal government because of increased federal-matching rates in recent years, he said, but that is changing this year as the matching-rate for the traditional Medicaid program is being cut by the federal government.

“That is not fixed financing with regards to our federal partners,” Corbett said. “It changes every year.”

To offset the reduction in federal matching funds will require an additional $24.4 million in state appropriations in the next state-budget year, according to OHCA officials.

In addition, officials anticipate the cost of serving those enrolled in the traditional Medicaid program will increase 2.6 percent in the next year while the cost of serving those enrolled in Medicaid through the Obamacare expansion will surge 6 percent next year. As a result, OHCA officials are requesting another $52.3 million for maintenance of the existing program, along with the $24.4 million to offset declining federal payments.

Those increased state expenses may be only a glimpse of more to come.

OHCA’s budget presentation showed that the per-person cost of Medicaid enrollees has been on a steady upward swing, increasing from $4,831 per person per year in the 2020 budget year to $5,385 per person in the coming state budget year, an increase of more than 11 percent in just three years.

And, while Medicaid expansion was touted by supporters as a way to save rural hospitals, OHCA budget materials show the vast majority of expansion funds are likely going to urban facilities. OHCA figures show 61 percent of expansion enrollees live in urban areas.

Clipped from: https://www.ocpathink.org/post/oklahomas-medicaid-costs-surging

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Size of Medicaid Expansion Influenced Administrative Spending

MM Curator summary

[ MM Curator Summary]: States that had more room to grow (ie had higher uninsurance rates) benefitted more when they expanded (in terms of administrative costs), likely due to economies of scale and handing over more scope to MCOs.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

 
 

States that enacted Medicaid expansion and had high uninsurance rates among low-income residents were considered large expansion states and subsequently saw a slight decrease in administrative spending.

 
 

Source: Getty Images

 
 

By Victoria Bailey

November 30, 2021 – Medicaid expansion did not impact overall administrative spending, but states with large expansions saw slight reductions in spending while smaller expansions led to minor increases, according to a Health Affairs report.

Administrative spending covers expenditures for eligibility and enrollment assessments and processes, interagency costs, claims processing, information technology systems, and more. States did not receive reimbursement for administrative costs following Medicaid expansion, and there is little research that speaks to whether expansion impacted this spending.

Researchers from Indiana University gathered data from all fifty states and focused on two outcomes in each state: the percentage of total spending that was administrative and per enrollee administrative spending.

State expansion, spending, and enrollment data from 2007 to 2017 were obtained through various CMS and Kaiser Family Foundation (KFF) reports.

The Health Affairs report looks at the differences in administrative spending between states that have expanded Medicaid and nonexpansion states. Additionally, the researchers compared large expansion states to small expansion states and states that expanded Medicaid traditionally through the Affordable Care Act to states that used Section 1115 to expand their program through waivers.

Researchers classified expansions as large or small by using the median uninsurance rate among nonelderly adults who had incomes below 100 percent of the federal poverty level in the year before the expansion. If the uninsurance rate was high, expansions were considered large.

Medicaid expansion became optional for states in 2014. Since then, 38 states and Washington DC have expanded their Medicaid programs.

Prior to 2014, expansion and nonexpansion states had similar levels of administrative spending, but most expansion states saw a larger unadjusted decline in per enrollee administrative spending after expanding their programs, researchers found.

The average annual per enrollee administrative spending in nonexpansion states before 2014 was slightly more than $444. Between 2014 and 2017, it fell to a little over $408, signifying a $35.60 decrease.

States that underwent large expansions saw a $106 annual decrease, going from an average of $507 per enrollee administrative spending pre-2014 to $401 between 2014 and 2017. States that had small expansions saw a slighter decrease of $20.99.

The adjusted analysis revealed very few differences in per enrollee administrative spending for nonexpansion and expansion states, including states that used ACA expansion methods and ones that expanded through waivers.

When categorizing Medicaid expansion states by expansion size, the differences were slightly more apparent. States that had large expansions saw a significant decrease in per enrollee administrative spending of $77 compared to nonexpansion states, while states with small expansions saw a nonsignificant increase compared to nonexpansion states.

In looking at the percentage of total spending that is administrative, researchers found similar results. Large expansion states had a nonsignificant reduction compared to nonexpansion states. Meanwhile, small expansion states had a significant increase in the percentage of spending that was administrative compared to nonexpansion states.

Overall, Medicaid expansion did not significantly escalate administrative spending for expansion states. But when considering expansion sizes, small expansions led to slight increases in administrative spending.

“States with larger expansions may experience economies of scale, where it becomes less expensive and they become more efficient as more people are enrolled in the program,” the report stated.

Additionally, states with larger expansions are known to have stricter eligibility criteria and may spend less on Medicaid overall, according to the researchers.

Small expansion states may have seen increases in administrative spending due to differences in reimbursement rates, application requirements, and eligibility and enrollment processes. States with smaller expansions also tend to have more generous Medicaid programs, which could exhibit higher spending, the report noted.

Twelve states have yet to expand Medicaid, barring access to healthcare coverage for many of their residents. Most of these states have high uninsurance rates and low eligibility thresholds which would lead to large expansions, researchers said. According to the study results, these expansions would increase coverage access while also reducing administrative spending.

The American Rescue Plan Act is encouraging states to expand Medicaid as well by offering an increase in federal medical assistance percentages (FMAP) for the first two years after expansion.

 
 

Clipped from: https://healthpayerintelligence.com/news/size-of-medicaid-expansion-influenced-administrative-spending