Medicaid

Data regarding federal and state Medicaid expenditures from 2004 to 2014 show the significant impact the Great Recession had on the federal-state partnership program. Enrollment and expenditures increased during the 10-year period; however, the increased program costs were borne disproportionately by the federal government.

Florida’s Gov. Scott took the Obama administration to federal court on April 28, claiming that they are attempting to force the state to expand Medicaid by threatening to withdraw other federal health funds.

Increasing health care expenditures are a source of great worry to public officials. Perhaps new data that show that public programs – Medicare and Medicaid – seem to hold down per capita spending growth more than private insurance will provide some reassurance to officials as they consider expanding public programs in their states.

The Cleveland Clinic, one of the nation’s largest hospitals, reported a 40 percent drop in charity care and credited the good news to Ohio’s Medicaid expansion, according to Kaiser Health News. Free care costs fell from $171 million in 2013 to $101 million in 2014.

In Armstrong v. Exceptional Child Center the Supreme Court held 5-4 that Medicaid providers cannot rely on the Supremacy Clause or equity to sue states to enforce a Medicaid reimbursement statute. 

The Court’s rejection of a private cause of action under the Supremacy Clause has implications well beyond this case.  Had the Supreme Court ruled otherwise, the Supremacy Clause would have provided a cause of action for every federal statute that arguably conflicts with state law.  

I learned a few things last week when I was visiting with Indiana Rep. Ed Clere, one of the new co-chairs of CSG’s Health Public Policy Committee.

  • That week, the state announced the 100,000th person enrolled in the Medicaid expansion waiver, called HIP 2.0 in Indiana, after the program opened less than a month before. Indiana had three Medicaid managed care organizations already engaged in the state and the state Medicaid office and the
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State leaders are getting more creative with their plans for how to expand Medicaid under the Affordable Care Act as they move away from traditional Medicaid programs, but they might be making it harder for those plans to be carried out. The Affordable Care Act gave states the option to expand Medicaid coverage to people who earn up to 138 percent of the federal poverty level. Several states have filed what are known as Section 1115 waivers which allow states to put their own spin on expansion. The waivers must be approved by the U.S. Department of Health and Human Services before implementation. Jesse Cross-Call, a policy analyst with the Center on Budget and Policy Priorities, said Arkansas was a trailblazer in Medicaid waiver design. Cross-Call was one of the featured speakers on a recent CSG eCademy webcast, “The Latest on Federal Medicaid Waivers.”

States that previously were reluctant to expand Medicaid eligibility as allowed under the Affordable Care Act are considering waivers for expansion designed with their state politics and health care system in mind. Several governors met with President Obama in January to advocate for their proposals. This eCademy session addresses how much flexibility states have under Section 1115 waivers and provides an overview of state waiver proposals.

 

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On Friday, Feb. 6, the Wyoming Senate voted 19 to 11 to reject a bill to expand Medicaid, WyoFile.com reported.

Majority Floor Leader Sen. Eli Bebout said, according to Wyo.File reporting, “Now is not the time. I think being cautious, and doing it the Wyoming way is the way we do things.”

The Senate Health Committee defeated Gov. Bill Haslam’s proposal to expand Medicaid in a 7-4 vote yesterday, according to the Times Free Press. Later in the day, both the House and Senate voted to adjourn the special session that had been called to consider the measure.

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