Medicaid

CSG Midwest
Wisconsin has received federal approval of changes to its Medicaid program that include requiring work for some enrollees and charging higher premiums based on the results of a health risk assessment. The approved waiver centers on childless adults applying for and receiving coverage through the public health insurance program. According to The Washington Post, Wisconsin also had originally sought to become the first state in the nation to impose drug tests on some of its Medicaid population. This requirement did not receive federal approval.

Ballot measures to expand Medicaid eligibility in Idaho, Nebraska and Utah passed in the mid-term elections. Montana voters rejected a measure to continue the expansion in their state.

For three days in September 2018, state legislative leaders in the health arena will meet at the CSG Medicaid Leadership Academy to hear from federal government representatives and officials from health policy organizations and state Medicaid programs about innovative programs in states that are improving health outcomes and reducing health care costs.

Presentation topics will include dementia-competent care in Virginia, a telehealth diabetes monitoring program in Mississippi, a proposal in Oklahoma to move to value-based...

A new organization in Utah, the Utah Alliance for the Determinants of Health, has been formed to improve overall community health by addressing social needs such as housing instability, utility needs, food insecurity, interpersonal violence and transportation. These are all non-medical factors that influence a person’s health. Public health researchers suggest that social determinants of health may account for up to 60 percent of health outcomes.

Virginia Legislature Votes for Expansion

On May 30, the Virginia Senate voted, with 4 Republicans supporting the measure, to expand Medicaid eligibility to all individuals with income at or below 138 percent of the federal poverty line, according to the Washington Post. Later in the day, the House of Delegates approved the bill by 67 to 31. Gov. Northam, a pediatrician who campaigned in 2017 on expanding Medicaid, is expected to sign the bill.

While state policy makers frequently express concern about the increasing percentage of state funds required to fund their Medicaid programs, the programs bring in large amounts of federal dollars to states. Across all states, two thirds of all federal grant funds received by states in 2017 are for Medicaid health services for low-income, disabled and elderly individuals. 

Jason Helgerson, leaving his job this week as New York Medicaid director after 7 years,  blogged in Health Affairs about the lessons he learned.  He says in the post that when his New York experience is combined with the previous 4 years as Wisconsin Medicaid director, he is the nation’s longest-serving Medicaid director. The average tenure of a Medicaid director, according to Helgerson, is 19 months.

Earlier this week, the head of the U.S. Centers for Medicare and Medicaid, Seema Verma, travelled to Arkansas and signed a waiver request to require Medicaid enrollees to work or prepare for a job. The work requirement will only impact the expansion population, specifically childless adults 19 to 49 years old. They will be required to work or participate in activities such as volunteering or vocational training for 20 hours per week. The requirement will be phased in between June and September 2018.

CSG Midwest
The idea of requiring able-bodied adults to work or be actively seeking it as a condition for government assistance is certainly not new, but its application to Medicaid is as of January, when the Trump administration began approving some states’ applications to impose work rules as a condition of eligibility for this public health insurance program.

According to The Hill, the Senate measure approved earlier today, Jan. 22, included six years funding for the Children's Health Insurance Program, also know as CHIP.

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