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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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.

The poverty guidelines for 2015 are available and published here in the Federal Register. These guidelines -- often cited as 100 percent of the federal poverty line -- are used to determine eligibility for a number of stata and federal programs. Sometimes eligibility is greater than 100 percent; for instance, the Affordable Care Act allows states to expand Medicaid eligibility to 138 percent of federal poverty. 

Gov. Mike Pence announced today federal approval of his state’s Medicaid waiver to expand eligibility to all persons with incomes below 138 percent of the federal poverty level, according to the Indy Star newspaper.

Pence has lobbied hard for what he calls HIP 2.0, expanding a smaller consumer-driven health plan called Healthy Indiana Plan, rather than expand the traditional Medicaid program.

“The expanded and updated HIP 2.0 is based on a program that has been serving 60,000 low-income Hoosiers in our state for seven years,” said Governor Pence in a press release. “It is a proven model for Medicaid reform across the nation.”

Up to 350,000 people will be eligible according to the press release. The state will start taking applications today, Jan. 27, for coverage to begin on Feb. 1, 2015.

Top Five 2015 Health Issues: A Further Examination

A flurry of state governors - in the 24 states that have not yet expanded Medicaid - are talking about expanding Medicaid eligibility as allowed under the Affordable Care Act. Many of these governors are offering up solutions that they say are designed uniquely for their state, carefully differentiating the new proposals from “traditional” Medicaid. This activity is likely to continue throughout 2015. Outside ACA issues, states will consider a number of health delivery issues. These include how to match the workforce to the need for professionals and how to expand some service areas such as mental health and substance abuse.

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