Tag: Medicaid Reform

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Medicaid expansion ballot initiative groundwork underway in Mississippi

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Hospitals are working to get more Medicaid payments in MS by funding the effort to get Medicaid expansion on the 2022 ballot under “Initiative 76.”

 
 

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.

 
 

 
 

JACKSON, Miss. (WLBT) – Many Mississippi politicians continue to push back on the idea of Medicaid expansion. But efforts are ramping up to put it to a vote by the people.

President and CEO of the Mississippi Hospital Association, Tim Moore, along with Hattiesburg pediatrician Dr. John Gaudet and advocate Dr. Nakeitra Burse formed the non-profit Healthcare for Mississippi.

They’ve now filed the paperwork for Initiative 76.

Friday morning, the Mississippi Hospital Association’s board of governors voted to partner with the non-profit on the effort. Signature collection should start next month with a goal of getting the ballot initiative on the 2022 ballot.

The exact language for Initiative 76 is still being ironed out. It’s goal, though, is to expand Medicaid to those who fall in the “coverage gap” of making too much to be eligible for Medicaid but not enough to afford private insurance.

“Since the legislature has not taken action in all this time then really, why do it now? Let the people decide,” said Mississippi Hospital Association President/CEO Tim Moore. “If it has been too hot of a topic politically to touch then let’s let Mississippi decide and move forward with it.”

“I really hope this does not become a political issue,” noted Dr. John Gaudet. “When I’m talking about healthcare, I’m not talking to Democrats, Republicans or Independents. I’m talking to Mississippians.”

The Millsaps College/Chism Strategies State of the State Survey from January 2020 asked if people would support Medicaid expansion. The answers reveal 60 percent of those polled support expansion.

We asked Governor Tate Reeves about the ballot initiative this week.

“Governing through the initiative process has some advantages… people get to be heard,” he said. “But it also has some significant disadvantages. I can assure you that however they write the question for the ballot, should they are able to get it on there, they’re going to leave out that minor part about it costing hundreds of millions of dollars more per year if we were to expand Medicaid.”

The framework for expansion is the federal government paying 90 percent of the cost, the state covering 10 percent. And states that haven’t expanded are being offered additional incentives now.

“It’s undeniably confusing as to why we would not take advantage of it,” added Moore. “We’ve seen study after study, even if the state paid the full match… it pays for itself over time.”

Although the Hospital Association has previously presented the Mississippi Cares plan that would have hospitals and plan members covering the state’s 10 percent share, that will not be referenced in the ballot initiative language.

 
 

Clipped from: https://www.wmcactionnews5.com/2021/04/11/medicaid-expansion-ballot-initiative-groundwork-underway-mississippi/

 
 

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Around the nation: CMS rescinds Medicaid work requirements in 2 more states

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Biden’s CMS is “withdrawing approval” of waivers previously approved by CMS.

 
 

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.

 
 

CMS in letters sent Tuesday to health officials in Michigan and Wisconsin wrote that it’s withdrawing its approval for the states to implement work requirements for Medicaid beneficiaries, in today’s bite-sized hospital and health industry news from Georgia, Maryland, and South Carolina.

  • Georgia: Gov. Brian Kemp (R) has lifted all of Georgia’s coronavirus-related restrictions, meaning the state’s ban on large gatherings as well as shelter-in-place and social distancing requirements are no longer in effect. The rollback of measures took effect on April 8 and will remain in place through April 30. “We know hard-working Georgians cannot endure another year like that last,” Kemp said. “That is why … we are loosening the remaining restrictions on our economy here in Georgia” (Lonas, The Hill, 4/7; Associated Press, 3/31).

 
 

  • Maryland: CMS in letters sent Tuesday to health officials in Michigan and Wisconsin wrote that it’s withdrawing its approval for the states to implement work requirements for Medicaid beneficiaries. Under former President Donald Trump’s administration, CMS approved Medicaid work requirements in 12 states. CMS has so far withdrawn those approvals in a total of four states, including Arkansas and New Hampshire (Ollove, Stateline, 4/7; Haefner, Becker’s Payer Issues, 4/7).

 
 

  • South Carolina: Trident Health has named Christina Oh as its CEO, effective May 3. Oh currently serves as CEO of Abrazo West hospital in Arizona and previously held executive positions at Piedmont Medical Center and Placentia-Linda Hospital in California. Oh will succeed Todd Gallati, who spent 13 years as president and CEO of Trident (Gooch, Becker’s Hospital Review, 4/6).

 
 

Clipped from: https://www.advisory.com/daily-briefing/2021/04/12/around-the-nation

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Biden administration confirms plan to end Wisconsin Medicaid work requirement

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Biden’s CMS is “withdrawing approval” of waivers previously approved by CMS.

 
 

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.

 
 

A work requirement for some BadgerCare recipients — which was already on hold during the COVID-19 pandemic — has been eliminated, the federal government has confirmed.

The work requirement was part of a Medicaid waiver for which the administration of former Gov. Scott Walker received approval in 2018. It had not been implemented before the COVID-19 pandemic, when it was suspended, and now will not be implemented at all.

The Center for Medicare & Medicaid Services (CMS) in the federal Department of Health and Human Services told the Wisconsin Department of Health Services (DHS) in a letter on Tuesday that it was withdrawing permission for the state to impose the requirement.

“CMS has determined that, on balance, the authorities that permit Wisconsin to require work and community engagement as a condition of eligibility are not likely to promote the objectives of the Medicaid statute,” the letter states.

The “community engagement requirement” specified that adults without children who applied for BadgerCare would have to document at least 80 hours a month of either work, education, job training or community service in order to stay eligible for health coverage.

The requirement was enacted in Walker’s 2015-17 budget; under the Trump administration, CMS approved it in October 2018. The next month, Walker lost-reelection, but before leaving office he signed legislation that blocked incoming Gov. Tony Evers from canceling the requirement. DHS began preparing to implement it, but the requirement was put on hold in March 2020. A federal law that gave states a 6.2% boost in their Medicaid dollars during the federal public health emergency required them not to kick any Medicaid recipients off the program in return for the funds.

Less than a month after President Joe Biden’s inauguration, the incoming federal administration indicated it would probably withdraw the Trump administration’s authorization of work requirements in Wisconsin and other states.

Although the Walker administration justified the requirement as a means to foster independence and encourage people to work, courts in other states have overturned such restrictions, ruling the goal of the original federal Medicaid law was solely to expand health insurance access, not encourage employment.

Research has found that most people on Medicaid who are able to work are already working, and that most of the people excluded by a work requirement qualified but couldn’t keep up with the task of filing regular reports to verify their work status. “In short, work requirements don’t help work, but they do push people off health insurance,” Donald Moynihan, a professor of public policy at Georgetown University and former director of the Robert M. La Follette School of Public Affairs at the University of Wisconsin, told the Wisconsin Examiner earlier this year.

 
 

Clipped from: https://wisconsinexaminer.com/brief/biden-administration-confirms-plan-to-end-wisconsin-medicaid-work-requirement/

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Medicaid expansion campaign kicks off in South Dakota

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Dems in South Dakota are working to get expansion on the ballot in 2022.

 
 

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.

 
 

The recent federal stimulus bill included provisions incentivizing states to expand Medicaid coverage. While states including Wyoming have moved Medicaid expansion forward legislatively, Dakotans for Health, a political advocacy group, is working to put the policy forward as a ballot initiative in South Dakota’s 2022 elections.

The South Dakota ballot initiative process requires petitioners to collect signatures totaling 10% of votes cast in the previous gubernatorial election to put a constitutional amendment on the ballot. For 2022, this is equivalent to 37,000 signatures. Signatures must be submitted by November 8.

In addition to this, Michael Card, a political science professor at USD, said the South Dakota legislature has referred a measure, House Joint Resolution 5003, to voters on the June 2022 primary ballot. This measure would place a 60% threshold on any initiated measure or constitutional amendment with a cost greater than $10 million over the first five years. Medicaid expansion falls under that level of budgetary impact.

“The committee proposing the Medicaid expansion has filed a lawsuit against this going into effect,” Card said.

Under the Affordable Care Act, the federal government would cover 90% of the costs of expanding Medicaid, leaving 10% to the state. Matthew Heard, a professor of health services administration at USD,
said this would cost the state about $60 million over the next five years.

“Might not seem like a big figure, but remember, we are a balanced budget state and $60 million dollars is about 3.5% of our state’s general fund budget,” Heard said said in an email interview with The Volante.

In addition, South Dakota’s revenues depend largely on a state sales tax, which can fluctuate depending on economic activity in the state.

“I think we always have to be concerned with whether a program will be sustainable or not,” Heard said. “Hopefully in the upcoming months, we will see our economy start trending back toward whatever normal is and we will see these sales tax revenues take off.”

Heard said while current South Dakota law places a number of limitations on persons applying for Medicaid, expansion would qualify all adults up to age 64 who earn up to 138% of the federal poverty line.

“Currently, we have nearly 115,000 South Dakotans on Medicaid or CHIP (Children’s Health Insurance Program),” Heard said. “Medicaid expansion would mean an estimated 45-50 thousand more people would be eligible for Medicaid.”

Under current South Dakota law, no adults without children and who are not disabled qualify for Medicaid, regardless of income, according to reporting from PBS.

Pam Cole, an organizer with Dakotans for Health, said the weather and pandemic have been the biggest challenges for signature gathering.

“Getting out there where people are congregating, you know, in finding enough signatures,” Cole said. “So you know, COVID, people are still social distancing.”

In addition, the group is challenging H.R. 5003 in the South Dakota Supreme Court. Cole said the court will make a decision in the next couple of weeks.

Remi Bald Eagle, a liaison for tribal outreach at Dakotans for Health, said the policy would have benefits for the reservations in South Dakota.

“It would allow more tribal members to qualify for Medicaid,” Bald Eagle said. “And what that does, is it allows more treatment options at the IHS (Indian Health Service).”

Benefits would include revenue from referred care. Bald Eagle said while currently the IHS must pay for referred care services, if individuals qualified for Medicaid, these services could be billed third party.

“If they can bill for more people and get that third party billing to the service unit, then that qualifies even more people for referred care because it enlarges their budget,” Bald Eagle said. “A lot of people don’t realize that 25-50% of a service unit on a reservation or a hospital budget is that third party billing revenue.”

Heard said about 24% of people who would become eligible under Medicaid expansion in South Dakota are Native American. 

“I believe IHS offers free care for Native Americans, but access to the care and treatments are often limited,” Heard said.

Those who would qualify under expanded Medicaid but currently don’t can get coverage through the Affordable Care Act exchanges. However, Cole said that coverage is often inadequate.

“It doesn’t help them with pharmaceuticals,” Cole said. “On a daily basis, they’re really literally left out in the cold with healthcare.”

Petitioners must validate at least 17,000 signatures by June 28. Cole said students who are interested in the campaign for Medicaid expansion can circulate petitions by going to Dakotans4Health.com.

 
 

Clipped from: http://volanteonline.com/2021/04/medicaid-expansion-campaign-kicks-off-in-south-dakota/

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Iowa Senate approves pilot program allowing Medicaid recipients to have direct primary care agreements

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Iowa will pay for Medicaid members to have direct primary care services, sans MCO involvement.

 
 

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.

 
 

 
 

(Des Moines) — The Iowa Senate has given approval to a pilot program that would allow certain Medicaid members to participate in direct primary care agreements.

By a 28-17 vote, the Senate approved SF81, which instructs the Department of Human Services to develop a pilot program starting in 2022 that would allow childless adults and pregnant women to receive basic health care from a physician using a monthly fee system, versus a fee-for-service approach. Senator Julian Garrett — a Republican from Indianola — says direct primary care agreements allow patients to pay providers directly and cuts out the insurance process.

“The advantage to these agreements is that it eliminates a tremendous amount of paperwork and red tape,” said Garrett.  “The patient just pays a monthly fee to the healthcare provider for their basic health care needs.  They need to make other provisions for the catastrophic examples such as cancer and things of that kind.”

Under the pilot program, Medicaid recipients in the identified categories would be able to enter into an agreement with a provider with the state footing the bill.

“The state would pay the monthly fee for a number of Medicaid patients for the pilot,” said Garrett.  “The state would have to continue to pay the big ticket items as they do now.”

Garrett says the program will save the state and the managed care organizations that run Medicaid money. Democratic Senator Amanda Ragan of Mason City says the proposal will not save the state money, because all of the money for the agreements must be paid by the state, instead of using federal match funds under the traditional model.

“I’m not certain why you would think the Medicaid population would be the best fit for this,” said Ragan.  “And it’s duplicative, because you’re going to still pay that fee — that capitated rate — for every one of those people that you have in that pilot.  That’s not going to stop.  If you truly believe that managed care is the best thing since sliced bread, this bill says it isn’t.”

The non-partisan Legislative Services Agency says the financial impact of the bill cannot be determined until they know how many participants will be enrolled in the program and the cost of each direct care agreement. Current estimates place the monthly payment for each participant between $50 and $150 per month. The bill now heads to the House for consideration.

Thank you for reading kmaland.com

At KMA, we attempt to be accurate in our reporting. If you see a typo or mistake in a story, please contact us by emailing kmaradio@kmaland.com.

 
 

Clipped from: https://www.kmaland.com/news/iowa-senate-approves-pilot-program-allowing-medicaid-recipients-to-have-direct-primary-care-agreements/article_0b368992-9232-11eb-b447-bb83e3b93d40.html

 

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Biden Proposes The Biggest Medicaid Home-Based Long-Term Care Expansion In History, But….

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Biden proposes adding $400B over eight years for Medicaid HCBS services.

 
 

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.

 
 

 
 

Louis and Katherine Bourgoin of Lewiston, who are two of the more than 6,000 Mainers who face losing … [+] health care provided through Medicaid. (Photo by Shawn Patrick Ouellette/Portland Press Herald via Getty Images)

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In his American Jobs Plan, President Biden has proposed increasing federal support for home-based long-term care by a staggering $400 billion over eight years. A $50 billion annual increase would represent a roughly 40 percent increase in the $129 billion Medicaid spent on long-term care in 2018 and a 70 percent increase in that year’s home and community-based services (HCBS) budget.

And it would come on top of a one-year $12 billion hike in the federal contribution to Medicaid HCBS that Congress passed as part of the American Rescue Plan in early March. Combined, the two initiatives are by far the biggest expansion of Medicaid HCBS the US ever has seen.

Biden and Congress still must turn the $400 billion promise into an actual plan. And the details will determine how transformative this initiative is.

Ambitious, but limited

Yet, for all its ambition, Biden’s plan won’t fully address the nation’s long-term care problems. It focuses on only one piece the puzzle—Medicaid HCBS. And it still won’t provide sufficient services for many older adults and younger people with disabilities who rely on Medicaid for their care. It doesn’t boost funding for a long list of non-Medicaid federal programs that are critical to those living at home. And it does nothing at all for middle-income Americans who are unable to pay for long-term care insurance but are not poor enough to qualify for Medicaid.

Biden’s latest proposal generally tracks the long-term care plan he proposed during his presidential campaign. Yet, by scaling back on some of the details in that plan, he significantly improved it. In the campaign, Biden tied $450 billion in new funding primarily to a single initiative: eliminating the Medicaid HCBS waiting lists that plagues many states.  

While reducing those waits is extremely important, spending nearly all of the added federal Medicaid HCBS dollars on that single priority would have left little for other critical initiatives. And, perversely, throwing money at states with long waiting lists would have rewarded those states that most delay access to long-term care.

More flexibility, conflicting goals

The American Jobs Plan, by contrast, gives Biden and Congress vastly more flexibility in how to spend those extra dollars. And that is important because truly reforming Medicaid long-term care will require a broad range of changes, each of which costs substantial amounts of money.

Attracting enough workers  to meet the expanded demand for home care will require higher pay and better benefits. Providing sufficient levels of care to maintain or even improve a beneficiary’s quality of life will mean raising her individual level of service, such as funding more hours of a personal care aide or a wheelchair ramp. Reducing waiting lists will require a greater overall supply of services and supports to serve many more people.

Policymakers also will need to decide whether to increase eligibility for Medicaid HCBS so more people who are unable to afford long-term care on their own can enroll in the program.

The problem, of course, is that given a finite amount of money, all these laudable goals conflict with one another. The more direct care workers are paid, the fewer hours of care they can deliver. The more services Medicaid provides to currently eligible beneficiaries, the fewer resources it has to expand the program to more people.

Missing pieces

Which brings me to another alternative Biden did not propose. Instead—or, perhaps, in addition to— expanding Medicaid HCBS, Congress could create a fully funded public long-term care insurance program. That would make it possible for people to get the care they need without relying on Medicaid at all.

There is a final critical piece of the puzzle that Biden also left out. To live at home, frail older adults or other people with disabilities need a broad, well-functioning infrastructure of care that government now funds outside of Medicaid. This starts, obviously, with appropriate, affordable housing. It goes without saying: With no place to live, home-based alternatives are useless.

Indeed, the one program Biden specifically called out for more support is Money Follows The Person, an initiative aimed at transferring nursing home residents back to the community. But while MFP has many benefits, it has helped relatively few older adults—in part because so many have no home to return to.  

But more than just housing, a well-functioning home-based system of long-term care also requires transportation, home-delivered meals, adult day, information services, and family caregiver support among many other services. If Biden hopes to increase the level of care for those living at home with severe functional or cognitive limitations, he is going to have to fund all of these programs as well.

These objections aside, Biden has taken a giant step towards reforming Medicaid’s dysfunctional system of long-term care—failures that were laid bare by the covid-19 pandemic. It will take months for Congress to work its way through the more than $2 trillion spending and tax increase package Biden proposed yesterday. It will be an enormous step forward for those with long-term care needs and their families if, at the end of the day, Biden’s new funding for Medicaid HCBS is part of the final plan.

 
 

Clipped from: https://www.forbes.com/sites/howardgleckman/2021/04/01/biden-proposes-the-biggest-medicaid-home-based-long-term-care-expansion-in-history-but/?sh=432d64fa1525

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Georgia’s congressional Dems urge Biden to scrap state’s Medicaid plan – Georgia Recorder

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GA lawmakers are working to undo the CMS-approved Medicaid expansion waiver.

 
 

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.

 
 

 
 

Democratic Sens. Raphael Warnock and Jon Ossoff joined House Democrats in a letter last week pushing health officials to pull the plug on the state’s plan “in its entirety as soon as possible.” Screenshot from a March 2021 Fox 28 livestream

This story was updated at 10:10 p.m. Monday. 

Georgia’s U.S. senators and congressional Democrats are urging the Biden administration to “fully rescind” a health care plan that federal officials first paused in February – and to do so soon.

Gov. Brian Kemp’s administration has pushed back on the Centers for Medicare and Medicaid Services’ decision to withdraw its approval of a Georgia plan that would slightly expand Medicaid to as many as 50,000 people if they complete 80 hours every month of work, community service or job training or if they are full-time higher education students. The federal agency objected to these strict eligibility requirements in a letter.

Georgia’s plan is still under review with no clear timeline for a decision, although state officials plan to start implementing the program this July. State officials have vowed to challenge any decision to revoke the federal government’s approval.

Democratic Sens. Raphael Warnock and Jon Ossoff joined House Democrats in a letter last week pushing health officials to pull the plug on the state’s plan “in its entirety as soon as possible.”

“Withdrawing approval for this (health care plan) is essential to ending the far-reaching efforts your predecessors made to block hundreds of thousands of low-income Georgians from accessing health insurance,” they wrote.

The letter, which was addressed to U.S. Heath Secretary Xavier Becerra and acting CMS administrator Elizabeth Richter, was distributed to reporters late Monday afternoon.

“Georgia Pathways and Access makes healthcare accessible – for the first time – to thousands and affordable for millions more,” said Cody Hall, a spokesman for the governor, referring also to a new reinsurance program designed to lower insurance premiums.

“CMS’ decision to halt our waiver programs at the eleventh hour, with the support of Senators Ossoff and Warnock, needlessly deprives these Georgians of health care during a pandemic,” Hall added.

The group wrote that the state should instead embrace the new federal incentives packed into the $1.9 trillion coronavirus relief package for the 12 holdout states like Georgia that did not expand Medicaid under the Affordable Care Act.

“The state’s misguided and inhumane demonstration is no substitute for health insurance that Georgians desperately need,” they wrote in the letter. “We urge you to immediately correct the wrongs of the past Administration and rescind Georgia’s Section 1115 waiver, while restoring the integrity of Medicaid, one of this country’s most critical and vital health care programs.”

The sweetened federal offer to expand could mean between $1.3 billion and $1.9 billion in funding for Georgia for two years, which could be a net gain of about $710 million to the state, according to the Kaiser Family Foundation. More than 500,000 low-income Georgians could gain health insurance coverage, including individuals who make about $18,000 a year.

Lawmakers have included $76 million in next year’s budget just to start building Georgia’s program. If the state cannot proceed with restrictive eligibility requirements, the plan would become much more expensive – potentially as much as $650 million, according to an analysis from the Georgia Budget and Policy Institute.

 
 

Clipped from: https://georgiarecorder.com/brief/georgias-congressional-dems-urge-biden-to-scrap-states-medicaid-plan/

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Medicaid Fraud Control Units Performed Poorly During the Pandemic

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A recent OIG report shows that recoveries during the pandemic dropped 48%.

 
 

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.

 
 

Updated on: March 25, 2021 By Knicole C. Emanuel Esq.

Original story posted on: March 24, 2021
 

The agency still recovered more than $1 billion from healthcare providers.

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) just published its annual survey of how well or poor Medicaid Fraud Control Units (MFCUs) across the country performed in 2020, during the ongoing COVID-19 pandemic.

Each state has its own MFCU to prosecute criminal and civil fraud. I promise that you do not want a MFCU to be calling or subpoena-ing you unexpectedly. The MFCUs reported that the pandemic created significant challenges for staff, operations, and court proceedings, which led to worse case outcomes in the 2020 fiscal year. But during that time, the MFCUs still recovered over $1 billion from healthcare providers, marking a 48 percent drop.

As MFCUs initially moved to a telework environment, some staff reported experiencing challenges conducting work because of limitations with computer equipment and network infrastructure. To help protect staff and members of the public from the pandemic, MFCUs reported curtailing some in-person field work, such as interviews of witnesses and suspects. These activities were further limited because of an initial lack of personal protective equipment that was needed in order to conduct similar activities in nursing homes and other facilities. Basically, COVID made for a bad recovery year by the MFCUs. Courts were closed for a while as well, slowing the prosecutorial process.

The report further demonstrated how lucrative the MFCU agencies are, despite the pandemic. For every dollar spent on the administration of a MFCU, it rakes in $3.36. In 2020, the MFCUs excluded 928 individuals or entities from participation in federal healthcare programs. There were 786 civil settlements and judgments; the vast majority of judgments involved pharmaceutical manufacturers. Convictions decreased drastically, going from 1,564 in 2019 to 1,017 in 2020. Interestingly, looking at the types of providers convicted or penalized, the vast majority were personal care service attendants and agencies, which were affected at a rate five times higher than that of the next most common provider type – nurses (LPNs, RNs, NPs, and PAs).

The Maine MFCU received the Inspector General’s Award for Excellence in Fighting Fraud, Waste, and Abuse for its high number of case outcomes across a mix of case types.

OIG also established desired performance indicators for 2021. OIG expects the MFCUs to maintain an indictment rate of 19 percent and a conviction rate of 89.1 percent.

The OIG report foreshadows 2021 MFCU actions:

  • Hospice: expect audits. No funds were recovered in 2020.
  • Fraud convictions increased for cardiologists and emergency medicine. Expect these areas to be more highly scrutinized, especially given all the COVID exceptions and rule amendments last year.
  • Expect a MFCU rally. The pandemic may not be over, but with increased vaccines, and after a down year, MFCUs will be bulls in the upcoming year.

While Medicare is strictly a federal program, Medicaid is funded with federal and state tax dollars. Therefore, each state’s regulations germane to Medicaid can vary. Medicaid fraud can be prosecuted as a federal or a state crime.

 
 

Clipped from: https://www.racmonitor.com/medicaid-fraud-control-units-performed-poorly-during-the-pandemic

 
 

 
 

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House puts Missouri voter-approved Medicaid expansion in limbo

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The funding bill to expand Medicaid has not been able to get enough votes in the house.

 
 

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 Gov. Mike Parson delivers the State of the State address Wednesday, Jan. 27, 2021, in Jefferson City, Mo. The speech is traditionally given in the House chamber but was moved to the smaller Senate chamber at the last minute due to concerns about the coronavirus. 

AP Photo/Jeff Roberson

(The Center Square) – Missouri’s Medicaid expansion goes into effect July 1 but House Republicans have thrown a wrench into implementing the voter-approved plan to extend health care coverage to 275,000 uninsured adults.

The House Budget Committee Thursday in a partisan 20-9 vote shot down House Bill 20, which sought to allocate $130 million in general revenue to secure $1.9 billion in federal funding to pay for the expansion Missouri voters approved in August by adopting Amendment 2.

The bill, crafted by House Budget Chair Rep. Cody Smith, R-Carthage, segregates Medicaid expansion appropriations from other Medicaid spending bills to be separately approved.

What happens next is uncertain. HB 20 does not have a Senate companion. It could find its way back onto the floor as the House deliberates Gov. Mike Parson’s $34.1 billion budget request next week.

Rep. Peter Merideth, D-St. Louis, said voters approved Amendment 2 and, by law, it must be implemented on July 1.

With the state only kicking in $130 million to garner nearly $2 billion in health care coverage – and flush with federal assistance allocations and sudden budgetary surpluses – maintaining the state can’t afford expansion is untrue, he said.

“We are being offered a false choice and a false narrative,” Merideth said.

Smith reiterated previously-stated arguments that state taxpayers cannot afford to subsidize health care for 275,000 adults and that the program needs to be streamlined and scrutinized.

“If we expand Medicaid without doing that we are simply pouring gasoline on the fire of problems that could come along due to increased spending,” Smith said.

“Are we willing to see the debt rise further?” said Budget Committee Vice Chairman Dirk Deaton, R-Noel. “Are we willing to take that vote, weaken our country at the expense of the Chinese and others?”

What debt? Democrats shot back. Missouri had a record budget surplus of $1.9 billion on March 1 and is expected to have $1.1 billion surplus on July 1.

“Stop acting like we don’t have money because you don’t want to give health care to people,” Merideth said. “It is a lie and ignoring what Missourians told us to do.”

Almost 1 million people are currently covered by Missouri’s Medicaid program, MOHealth.net. Amendment 2 requires the state to offer coverage to about 275,000 people with annual incomes up to $17,744 for an individual and $35,670 for a family of four.

Opponents argued Amendment 2 was illegal because the Missouri Constitution mandates that initiatives that require appropriations provide a dedicated source of money – not the state’s general fund – to pay for it.

The Western District Court of Appeals rejected legal challenges on the grounds that the funding source would be determined when the amendment was implemented.

That funding source was HB 20. Unless it is adopted, Republicans say, expansion cannot take place.

“If we want initiatives with appropriations, we need to be honest with the people and say where the money is coming from,” said Rep. David Evans, R-West Plains. “If they had drafted it, including what the constitution actually requires, it may not have gotten over that 50 percent mark.”

Parson’s budget request does not segregate Medicaid expansion costs and fully funds it, as he vowed to do after Amendment 2 was adopted despite opposing it.

The governor sets the cost of Medicaid expansion at $1.9 billion, including $120 million in state general revenues.

The overall budget proposal calls for $14.1 billion for Medicaid, including $2.7 billion in general revenue. Medicaid in Missouri cost $10.8 billion in fiscal 2020, about 4 percent more than the previous year, according to the state’s Department of Health.

 
 

Clipped from: https://www.kpvi.com/news/national_news/house-puts-missouri-voter-approved-medicaid-expansion-in-limbo/article_7d964f4f-74df-5353-9136-534d4694e8df.html

 
 

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Ga. GOP bets on limited Medicaid expansion despite fed’s push for more

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Georgia officials remain committed to a July 1 go-live date for their Medicaid expansion that is tied to work requirements.

 
 

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.

 
 

 
 

Georgia Gov. Brian Kemp plans to forge ahead with a limited version of Medicaid expansion that is now held up by the Biden administration. This is despite huge financial incentives to fully expand health care access in the recent federal $1.9 trillion COVID relief package. the_burtons/Getty Images

Georgia’s governor is pressing forward with a limited – and now uncertain – expansion of Medicaid coverage as supporters of fully expanding the program’s eligibility are championing new federal incentives.

The sweetened deal, which is baked into the latest round of coronavirus relief, targets the remaining 12 holdout states like Georgia that did not expand Medicaid under the Affordable Care Act.

A coalition of groups advocating for full expansion, Cover Georgia, took out full-page ads last week touting the new federal incentives in six newspapers, most of which cover communities that are home to the governor’s floor leaders and the General Assembly’s chief budget writers and leaders on health care. This year’s legislative session ends Wednesday, with any last-minute pivot to fully expand Medicaid unlikely.

Laura Colbert, who is the executive director of Georgians for a Healthy Future and a spokesperson for the coalition, said the advertising push was meant to drive awareness that “the landscape has pretty meaningfully shifted” when it comes to Medicaid expansion.

The new federal incentives could mean between $1.3 billion and $1.9 billion in federal funding for the state for two years, which could be a net gain of about $710 million to the state, according to the Kaiser Family Foundation. More than 500,000 low-income Georgians could gain health insurance coverage, including individuals who make about $18,000 a year.

The actual net gain for Georgia could be even closer to $1 billion, said Laura Harker, a senior policy analyst with the Georgia Budget and Policy Institute. The new federal perks may make a difference for some reluctant states, particularly depending on their budget needs. Georgia cut $2.2 billion from the budget last summer and has not fully restored those reductions but has seen its revenues grow.

The new incentives have already sparked interest in other GOP-controlled states, including Wyoming and Alabama.

“We’re also watching to see will this start some type of cascade effect that hopefully can leak over into Georgia,” Harker said.

The sweetened offer comes as a federal agency has halted progress on Gov. Brian Kemp’s waiver application for a limited expansion that would extend coverage to as many as 50,000. The state, though, has vowed to challenge any federal decision to revoke Georgia’s waiver application.

Lawmakers have included $76 million in next year’s budget just to start building Georgia’s program this July. And without the restrictive eligibility requirements, Georgia’s plan would become much more expensive – potentially as much as $650 million, according to GBPI.

GOP state leaders, like House Speaker David Ralston, continue to voice support for the governor’s plan.

Colbert said it’s still too early to understand whether the American Rescue Plan Act’s sweetener will win over Republican state leaders who have long called Medicaid expansion too costly. President Joe Biden signed the sweeping $1.9 trillion measure into law just this month.

Colbert said she worries state leaders will lose more time defending the governor’s health care plan.

“That’s a court case that could take years, and frankly, Georgians don’t have years to wait,” Colbert said. “And it’s silly for us to forego the benefits of expansion while waiting on a court case to play out on a program that isn’t as cost effective and doesn’t even cover as many people.”

‘Georgia will challenge the decision’

The uncertain status of the state’s limited expansion plan coupled with the sweetened deal from the White House has given state Democrats new fuel in their decade-long push for Georgia to expand the program under the Affordable Care Act.

“Y’all, come on. This is ridiculous,” state Sen. Jen Jordan, an Atlanta Democrat, said during a vote on next year’s budget. “We could cover (500,000) people in this state. We could send money to rural hospitals, we could up health care provider reimbursement rates across this state. And we’re not doing any of it.”

The Centers for Medicare and Medicaid Services under the Biden administration has objected to the Georgia program’s eligibility requirements, particularly during a pandemic. Participants would have to complete 80 hours of work or training each month to keep their health care coverage.

The federal agency is still weighing Georgia’s plan, which is part of a 10-state review process started in February under the new administration. Georgia’s health care plan was initially approved in October under former President Donald Trump.

“Medicaid’s primary objective, as outlined in statute, is to provide medical assistance serving our nation’s vulnerable and low-income individuals and families,” an agency spokesperson said in a statement. “CMS looks forward to collaborating with states — as it always has — on solutions that strengthen Medicaid’s aims.”

The state defended the program, called Georgia Pathways, in a response this month. Frank Berry, commissioner of the state Department of Community Health, said the eligibility requirements are essential to the state’s program and vowed to challenge any decision to revoke the state’s waiver.

Berry wrote that revoking the eligibility requirement “would be arbitrary, unreasonable, and unlawful.”

“The State welcomes the opportunity to discuss this matter with CMS further given the importance of providing this new coverage option for Georgians,” Berry wrote. “However, should CMS revoke approval of the waiver, Georgia will challenge the decision.”

When asked if the agency was also considering the new federal incentives, Fiona Roberts, a spokeswoman for the state Department of Community Health, said the legal teams for the state agency and the governor’s office “continue to review the American Rescue Plan.”

 
 

Clipped from: https://georgiarecorder.com/2021/03/29/ga-gop-bets-on-limited-medicaid-expansion-despite-feds-push-for-more/