Medicaid

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.

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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.

The Children’s Health Insurance Program – also known as CHIP – has figured prominently in the deliberations on keeping the federal government open. Reporting today by Governing magazine says that the details of the vote later today have not been made public, so the fate of the six-year funding appropriation for CHIP that was included in the House continuing resolution is unclear.

Yesterday, federal officials issued new guidance that will support “state efforts to improve Medicaid enrollee health outcomes by incentivizing community engagement among able-bodied, working-age Medicaid beneficiaries.” A number of Section 1115 waiver applications currently before the Department for Health and Human Services would impose work requirements in one way or another are expected to be approved under the new policy.

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An extensive new report from the Kaiser Family Foundation, “Medicaid Moving Ahead in Uncertain Times: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2017 and 2018,” provides an overview of states’ approaches to eligibility, premiums and managed care initiatives, emerging delivery system and payment reforms, long-term services and support reform, and provider rates and taxes.

On Tuesday, Nov. 7, Maine voters approved (59 percent of the vote) a ballot measure to expand Medicaid eligibility to an estimated 70,000 low-income individuals. Maine is the first state to approve Medicaid expansion through a voter referendum. It would bring the expansion total to 32 states and the District of Columbia.

Gov. Paul LePage, who has vetoed Medicaid expansion bills five times, has issued a statement saying he will not implement the measure unless the legislature fully funds it.

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