Federal Healthcare Reform

More than 20 legislators from 16 states--many of them in key leadership positions on health or budget committees that deal with Medicaid in their home states--attended a CSG policy academy in Washington D.C. on September 21-23, 2016, to learn how states are making reforms in their Medicaid program that pursue the health "triple aim": improving the quality of care for individuals, improving the health of populations, and reducing per capita costs of health care.

Gov. Matt Bevin, elected in November 2015 and who had pledged during his campaign to eliminate Medicaid expansion which brought health coverage to 400,000 previously uninsured individuals, announced yesterday his plan to transform Kentucky’s Medicaid system through an 1115 waiver. The new waiver will cover almost all the Medicaid enrollees eligible under the pre-expansion rules as well as all the newly eligible under the expansion rules.

Bevin said his plan is an opportunity “to come up with what is going to be truly a transformative and sustainable and fantastic program,” according The Courier-Journal coverage of the press conference. He pledged to both save money—$2.2 billion in combined state and federal funding over the next five years—and reduce the number of Medicaid enrollees—86,000 people by 2021 by moving them to private insurance.  

Despite pushing the federal government to provide 100 percent of the cost for health care for American Indians, what South Dakota Gov. Daugaard has characterized as a longstanding treaty obligation, on Feb. 29 Daugaard ruled out Medicaid expansion during this legislative session.

Last week, two states rejected Medicaid expansion, another is continuing negotiations with Washington and one is studying whether and how to continue expansion already in place and reduce the numbers of people eligible. Currently 31 states and the District of Columbia have expanded income eligibility for Medicaid as provided for by the Affordable Care Act. Sixteen states remain firmly in the non-expansion column.

On Tuesday, Jan. 12, John Bel Edwards signed his first executive order as Louisiana’s new governor to expand Medicaid eligibility to an estimated 300,000 individuals. The expansion is to be effective no later than July 1, 2016 according to the order.

Louisiana becomes the 31^st state (plus DC) to expand Medicaid income eligibility as permitted by the Affordable Care Act.