NEBRASKA
Nebraska has not been able to expand Medicaid for the previous seven years and the latest legislative effort, Legislative Resolution 281CA, is in gridlock between lawmakers. However, in March, Senator Morfeld backed a petition that would give citizens the opportunity to vote on the issue. Under the Insure the Good Life petition, 84,268 valid signatures were needed by July 6th in order to have the issue on November's ballot. The ballot initiative would extend coverage to 90,000 Nebraskans.
The petition effort exceeded the required amount of signatures with 133,000 submitted for review. While this boosted the outlook of expansion supporters, it has been countered by an attempt to block the petition. Two Republican lawmakers, Senators Lydia Brasch and Mark Christensen, have filed a lawsuit against the effort. The senators are worried about the negative effects it could have on taxes and also it's impact on existing coverage.
The proposal would expand coverage to single adults and couples without minor children that are not eligible for Medicaid presently. In addition, parents and disabled individuals whose income is up to 138% of the poverty level would be covered. Over an 8-year period, it's estimated that the expansion would cost Nebraska $100 million per year.
Meg Mandy, campaign manager for Insure the Good Life, denounced the lawsuit calling it, "a desperate attempt to block the people's ability to voice their opinion on this issue and ensure affordable health care for 90,000 Nebraskans." According to Mandy, these are "two politicians who have failed to find solutions for working Nebraskans to access health care."
IDAHO
Idaho's ballot initiative, Reclaim Idaho, strongly believes that expansion will save taxpayers money and aims to expand coverage to 62,000 citizens. Advocates of the initiative contend that the 62,000 individuals are in a coverage gap between Medicaid and insurance on the state exchange. They are either making too much money to receive Medicaid or not enough in order to secure insurance on the state exchange.
On July 17th, the initiative paid off and Idaho's Secretary of State, Lawerence Denney, verified that the ballot initiative had obtained enough signatures in order to have Medicaid expansion on November's general election ballot.
The initiative looks to extend coverage for those who are not otherwise eligible for any other coverage under the state plan. If passed, Medicaid eligibility will expand to include people under 65 whose modified adjusted gross income is 133% of the federal poverty level or below.
At the start of August, a number of Republicans began to show support for the initiative. Among the advocates was the chairman of the State's Legislature House Health and Welfare Committee, Fred Wood (R). He announced his endorsement for the initiative and told Times-News, "The Legislature's been struggling with this problem for years." The chairman believes that it is the best solution for the uninsured population within the coverage gap.
UTAH
Medicaid expansion is being pursued by two separate fronts in Utah. While advocacy groups are going after expansion through a ballot initiative, Governor Herbert has signed a bill asking for partial expansion from the federal government.
Bill HB472 would expand the state's Medicaid program under the stipulation that it would only expand to 100% of the Federal Poverty Level (FPL), instead of the federal mandate of 138%. By 2020, 72,000 residents would be eligible for coverage and the out of pocket expenses would be far less under the bill.
According to The New York Times, CMS is no longer considering Utah's partial expansion. However, that may change after the midterm elections.
On the ballot initiative front, Utah Decides obtained the required signatures in order to have expansion on the November 6th ballot. If approved by voters, the expansion would increase coverage to 138% of the FPL. That equates to almost $17,000 a person, or $34,000 for a family of four. It's estimated by organizers that an additional 150,000 adults would gain eligibility as a result of the expansion.
VIRGINIA
After almost 6 years of resistance from Republican legislators, Virginia voted in favor of Medicaid expansion under the ACA on May 30th, 2018. The provision to expand the state's Medicaid program to more than 400,000 Virginia residents was included in the General Assembly's approved budget. However, it came at a cost. Republicans only accepted the expansion under the condition that it would incorporate a 20-hour-a-week work requirement.
As Virginia prepares for Medicaid expansion there may be additional barriers ahead, postponing and possibly preventing the increased coverage. Critics consider the work requirement to be a violation of the law because it could possibly block a person from access to healthcare. They argue that many of the people that would be eligible for coverage under expansion would have to choose between working more hours and healthcare.
Regardless of the controversy over work requirements, government officials are confident that Medicaid will expand this coming year whether or not the requirements are enacted.
MAINE
Last November, Maine's Medicaid program received support for expansion after 59% of voters supported it through a ballot initiative. Despite its approval, the state's Governor, Paul LePage opposed the initiative and placed expansion in a legislative deadlock.
Governor LePage is concerned over the financial strain that expansion would put on the state. The governor stated, "this fiscally irresponsible Medicaid expansion will be ruinous to Maine's budget."
Shortly thereafter, Maine Equal Justice Partners submitted a lawsuit against DHHS for the failure to act and refuse residents coverage. MEJP asserts that the governor is denying newly eligible applicants coverage that is mandated by law. After evaluation, a Superior Court judge ruled in favor of MEJP; however, the state's administration is appealing the judgment. Presently, a decision on the matter is pending in Maine's Supreme Judicial Court.
At the moment, expansion is still in deadlock but that has not prevented citizens from applying for coverage. Additionally, the LePage administration and Maine's Department of Health and Human Services is promptly rejecting these applications. Despite the rejection of applications by the LePage administration, MEJP is instructing people to continue applying for Medicaid.
Nearly 80,000 low-income citizens would be eligible for Medicaid coverage as a result of the expansion. This number includes parents that were not formerly eligible and childless adults.
When asked about the status of expansion, DHHS has declined to comment due to the pending lawsuit. The state could end up spending nearly $200,000 for a lawyer to defend the LePage administration.
Regardless of the Trump administration's attempts to reform Medicaid on the federal level, a number of states are going after Medicaid expansion by carrying out ballot initiatives. These efforts are enabling voters to step out in front of their legislatures and voice their support for expansion at the polls this fall.
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