GAO CRITICIZES MEDI-CAL'S OUT-OF-DATE REPORTING MODEL AND IMPROVED MEDICAID OVERSIGHT

In August, the GAO issued a report to Congress that focused on what CMS would need in order to better target risks and improve Medicaid oversight. The review discovered that one of the critical problems the agency is facing is the failure to incorporate new reporting technology. Currently, California's Medicaid program is still using paper files to report expenses and that translates into thousands of documents.

Carolyn Yocom is the Health Care Director at the GAO that focuses on Medicaid. She stated, "For this type of reporting on expenditures, California really should be able to provide that electronically."

Medi-Cal provides services to 1 in 3 Californians with a combined federal and state budget of $104 billion annually. Presently, the state utilizes 92 separate computer systems to run the program. However, according to DHCS, "Given system limitations and the magnitude of the supporting documentation, providing it electronically is currently not feasible."

Over the course of the program's lifespan, Medi-Cal has been unsuccessful in implementing new technology. For example, in 2010 Xerox acquired a contract worth $1.7 billion to create a new system for the program. However, the deal was terminated after six years of delay and according to the state, Xerox paid more than $123 million as a settlement deal. Conduent was then spun off into a separate company from Xerox to continue running the system and process claims.

The issue is even more problematic when you take into consideration that California's outdated paper reporting system is not only a problem within the state but its also entrenched across the country's healthcare system.

States are mandated to send Medicaid data to the federal government on a quarterly basis. This data consists of expenses and supporting documentation including invoices, cost reports, and eligibility records. Even though California provides its spending reports electronically, its supporting documentation is not.

Recently, California has made some attempts to upgrade its systems that would result in improved Medicaid oversight. DXC Technology was granted a contract in August to take over some of the functions of Conduent. In addition, program officials are also planning for a new system that would cost an estimated $500 million. If approved, the federal government would be accountable for 90% of the design and implementation costs and the state would cover $50 million out of pocket.

As the state begins updating its operations, a remedy to the program's reporting issues remains a focus among government officials. According to Elaine Howle, a state auditor, Medicaid's information technologies system, "needs to be replaced, because it is more than 40 years old, its operations are inefficient, maintaining the system is difficult and there is a high risk of system failure."

Howle wrote a letter to Governor Brown and other officials in June. She stated that California is paying roughly $30 million a year to maintain the 40-year old system.

The GAO also criticized CMS for its lack of Medicaid oversight. The report disagreed with the fact that the agency appoints nearly the same amount of staff to review case files regardless of the size of a state's program. As an example, under the ACA, California had ten times the amount of new enrollees as Arkansas. For that reason, California is at higher risk of enrollment errors and improper payments due to its program's size. Regardless of the substantial difference in enrollment figures, both states were assigned 30 staff members to review claims. In addition, the authors of the report specified that California represents 15% of federal Medicaid spending, while Arkansas only represents 1%.

Carolyn Yocom commented that CMS "needs to step back and assess where are the biggest threats and vulnerabilities." She also stated, "If you aren't looking, you don't know what you aren't catching."

According to the GAO, from FY2014 to FY2018 federal Medicaid spending rose to around 31% and at the same time, CMS financial oversight decreased by about 19%.

In a July letter to the GAO, DHHS agreed with the report's Medicaid oversight recommendations and wrote that it "will complete a comprehensive national review to assess the risk of Medicaid expenditures reported by states and allocate resources based on risk."

Click here to read more. 

GOVERNMENT OFFICIALS AND AGENCIES LOOK INTO MEDICAID'S INTEGRITY

In 2017, improper payments within the Medicaid program reached a total of $37 billion according to CMS. That amounts to 10 percent of the federal dollars spent on the program. Furthermore, 99.2 percent of the payments made are overpayments.To make matters worse, under the current legislation, national health spending is predicted to reach $5.7 trillion by 2026. When considering the rising costs of healthcare and the programs growth from expansion under the Affordable Care Act, government officials are concerned over the programs sustainability.

In an effort to address Medicaid fraud and overpayments, the Senate Homeland Security and Governmental Affairs Committee held a hearing in June. Those present to investigate the problems and solutions were Chairman Senator Ron Johnson (R) WI, Senator Clair McCaskill (D) MO, Comptroller General of the United States Government Accountability Office, Eugene L. Dodaro, and the U.S. Department of Health and Human Services Assistant Inspector General for Audit Services, Brian P. Ritchie. Over the course of the hearing, the ranking members and witnesses discussed the rising costs associated with the Medicaid program and what efforts should be made so that federal funds are spent efficiently and effectively.

GAO Recommendations

Comptroller General Dodaro represented the GAO at the hearing and suggested actions to mitigate improper payments and program integrity risks. He indicated that Medicaid's unique state-by-state structures combined with the size of the program are two elements that make overseeing the program difficult.

The GAO identified improper payments, supplemental payments, and demonstrations as three areas of risk within Medicaid that are estimated to exceed $900 billion by 2025. In order to strengthen oversight and address risk, the GAO recommended the following:

Improve Data
"The Centers for Medicare & Medicaid Services (CMS), which oversees Medicaid, needs to make sustained efforts to ensure Medicaid data are timely, complete, and comparable from all states, and useful for program oversight. Data are also needed for oversight of supplemental payments and ensuring that demonstrations are meeting their stated goals."

Target Fraud
"CMS needs to conduct a fraud risk assessment for Medicaid, and design and implement a risk-based antifraud strategy for the program."

Collaborate
"There is a need for a collaborative approach to Medicaid oversight. State auditors have conducted evaluations that identified significant improper payments and outlined deficiencies in Medicaid processes that require resolution."

Click here to see the GAO's full report.

DHHS Recommendations

Inspector General for Audit Services, Brian P. Ritchie represented DHHS and also weighed-in on the obstacles facing Medicaid. The Inspector General identified high improper payments rates, inadequate program integrity safeguards, and beneficiary health and safety concerns as risks that jeopardize the integrity of the program. Additionally, he testified that in order to preserve the program there needs to be more robust efforts made in regards to prevention, detection, and enforcement.

According to Ritchie, "CMS must do more to ensure that Medicaid payments are made to the right provider, for the right amount, for the right service, on behalf of the right beneficiary."

DHHS emphasized the importance of complete and reliable national Medicaid data for successful oversight and program management. They determined that the deficiency in quality data obstructs enforcement efforts. DHHS advised that CMS do the following:

"Ensure the completeness and reliability of data in the Transformed Medicaid Statistical Information System"

"Ensure that States report encounter data for all managed care entities"

"Reduce improper and wasteful payments and ensuring compliance with fiscal controls"

"Improve the oversight of Eligibility Determinations"

"Ensure that national Medicaid data are complete, accurate, and timely" 

"Facilitate State Medicaid agencies' efforts to screen new and existing providers by ensuring the accessibility and quality of Medicare's enrollment data"

Read through the department's complete list of recommendations here.

CMS's Efforts To Address Medicaid's Improper Payments, Waste, Fraud, and Abuse

Nearly a month after the meeting, the Senate Homeland Security and Governmental Affairs Committee conducted an additional hearing with the Administrator of The Centers for Medicare and Medicaid Services and the US Comptroller General. The hearing concentrated on examining CMS's efforts to protect against fraud and overpayments within Medicaid. The GAO expressed that while CMS has taken measures to address these threats, additional action is needed in order to strengthen the program's integrity.

CMS's Administrator, Seema Verma, testified at the hearing and presented CMS's efforts. She discussed the following:

• New audits of state beneficiary eligibility determinations
• Targeted audits of state managed care claims for federal match funds and rate setting
• Addressing the inherited backlog of disallowances
• Designated State Health Programs (DSHP) funding phase-out
• Intergovernmental transfers
• Budget neutrality policies for 1115 Medicaid demonstration projects

Furthermore, Administrator Verma promoted the optimization of data. She also pointed out it's significance in protecting the integrity of the program

According to CMS, "Improving Medicaid and CHIP data and systems is a high priority. Through strong data and systems, CMS and States can drive toward better health outcomes and improve program integrity, performance, and financial management in Medicaid and CHIP."

CMS is working to strengthen the Medicaid program's integrity by employing advanced analytics and technologies for the collection of health services data. In June, each of the 50 states, including Washington D.C. and Puerto Rico, began sending data from their programs to the Transformed - Medicaid Statistical Information System (T-MSIS). The system is designed to keep track of key information such as: enhanced information about beneficiary eligibility, beneficiary and provider enrollment, service utilization, claims and managed care data, and expenditure data for Medicaid and CHIP. Moving forward, the agency will be in charge of determining the quality and completeness of the data submitted.

Click here to read Administrator Verma's full statement.

The Medicaid program is one of the nation's largest sources of funding for medical and health-related services. As a result of concerns over the program's fiscal oversight and it's substantial amount of improper payments, Medicaid has been on the GAO's "High Risk List" since 2003. As the program continues to expand, government officials and federal agencies are working to address issues rooted in waste, fraud, and abuse.

Learn more here.

AN UPDATE ON MEDICAID EXPANSION - IDAHO, NEBRASKA, UTAH, MAINE & VIRGINIA

Support for Medicaid expansion is on the rise as states move toward general elections this fall. Supporters of expansion have been busy in recent months as they aim to expand their programs through ballot initiatives. In May we reviewed a number of states considering expansion. Here is an up-date on their progress:

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.

Click here to learn more.

MEDICAID EXPANSION HAS IMPROVED THE ACCESS TO QUALITY CARE

While Medicaid expansion supporters are encouraged by the most recent developments in Maine and Virginia, there are concerns about the access to quality care as the Medicaid population expands. To answer these questions, a number of studies have been conducted to help assist the states considering expansion and those that are making adjustments to their current programs.

Medicaid Expansion And Rural Areas

Since the majority of the rural populations are below the poverty line and uninsured, rural areas across the nation rely on community health centers for primary care. The increased federal funding from the Affordable Care Act and Medicaid expansion were thought to be solutions for improving the access and quality of care for these communities.

In a report from Health Affairs titled, Medicaid Expansion And Community Health Centers: Care Quality And Service Use Increased For Rural Patients, analysts looked into the changes in quality and access between 2011 and 2015. After comparing community health centers from states that expanded with centers in states that did not, the report indicated that patients covered by Medicaid rose to 13% and uninsured patients decreased by 11%.

Researchers also reviewed urban centers from areas that expanded Medicaid with urban centers in areas that did not, but the study did not discover any notable changes to the quality of care.

As opposed to the urban community health centers, rural centers from states that expanded Medicaid saw substantial improvement. Researches strongly believe that these improvements may be a result of more affordable prescriptions under Medicaid or perhaps as a result of the fact that insurance access to care makes visits to health professionals less costly.

Are More Conservative Versions of Medicaid Working?

Health Indiana Plan 2.0 was the outcome of the state expanding Medicaid by way of the 1115 waiver process. In order to qualify, program enrollees are required to contribute to a health savings account. Any time an enrollee fails to make a payment, their benefits are reduced. Furthermore, enrollees that make more than the poverty line are locked out of coverage for 6 months if they miss a payment.

Indiana University explored the effects of the state's decision and compared it to other states that expanded. Using data from the American Community Survey, analysts aimed to see if adults between the ages of 18 and 64 had insurance coverage or Medicaid coverage from 2009 to 2016. According to their analysis, states that expanded their Medicaid programs saw greater gains in comparison to states that did not. Generally, states that had higher insurance coverage rates before expanding saw more gains. Out of 27 states, Indiana ranked in the middle at 13.

Regardless of Indiana's additional conditions for coverage, the state experienced notable Medicaid coverage gains. Whether or not the gains could have been larger without the requirements could not be determined. Also, Indiana's cost-sharing requirements may be the reason for the state's underperformance.

A 30,000 Foot View Of Medicaid After Expansion

From the start of Medicaid expansion, there have been 77 research studies released with 440 unique analyses. More than half of the studies indicate that the effects of Medicaid expansion are in line with the goals of the Affordable Care Act. 35% of the studies showed no significant discoveries and 4% discovered a negative effect after expanding Medicaid.

Up to this point, the studies that have been carried out show that the effects of Medicaid expansion have been positive. The lead author of Indiana University's study, The Effects Of Medicaid Expansion Under The ACA: A Systematic Review, Olena Mazurenko says "With dozens of scientific analyses spanning multiple years, the best evidence we currently have suggests that Medicaid expansion greatly improved access to care, generally improved quality of care, and to a lesser degree, positively affected people's health."

Click here and read more. 

TRUMP ADMINISTRATION INDICATING POTENTIAL LIMITS TO MEDICAID 1115 WAIVER APPROVALS

From the very start of Donald Trump's presidency, he has vowed to grant states the flexibility they need to design their own Medicaid policies. HHS, collaborating with governors and state legislatures, could make dramatic state-by-state modifications to Medicaid using section 1115 waivers allowed under federal law.

Section 1115 waivers give states the possibility to forgo key provisions of federal Medicaid law. The changes made possible by Section 1115 waivers are not as dramatic as those featured in the failed bills. For example, states cannot use 1115 waivers to fully restructure Medicaid under block grants or per capita caps, neither can the federal government use them to eliminate federal reimbursements for Medicaid expansion; however, they are still significant.

Under the President Trump's administration, CMS has authorized 1115 waivers that the former administration consistently rejected. Many states, for instance, have been allowed to make employment a condition for Medicaid enrollment. (The state of Kentucky; however, is presently in court proceedings over the new policy.).

Trump's administration is likewise allowing Kentucky to require beneficiaries to report income changes while Arkansas is disenrolling beneficiaries for the remainder of the calendar year if they do not comply with the work requirement.

The list below is what CMS has previously declined, as well as what is still under deliberations:

MEDICAID 1115 WAIVERS THAT HAVE BEEN REJECTED BY CMS

Lifetime limits

In May, CMS rejected an 1115 waiver application from Kansas to set up a three-year time limit for people enrolled in the Medicaid program.

Joan Alker, executive director of the Center for Children and Families at Georgetown University, said in a statement that she was "... pleasantly surprised by that."

Utah, Wisconsin and Arizona have also sent similar 1115 waiver applications to CMS for lifetime limits, which Alker anticipates will also get rejected.

In a statement by Seema Verma concerning Kentucky's attempt to sanction lifetime limits on Medicaid enrollees, she stated "We seek to create a pathway out of poverty, but we also understand that people's circumstances change, and we must ensure that our programs are sustainable and available to them when they need and qualify for them."

Partial expansion

CMS rejected Arkansas' bid to decrease the number of people who qualify for the state's Medicaid program. Arkansas was looking to reduce the eligibility requirement from 138 percent of the federal poverty to 100 percent; however, it was not a firm denial, rather, CMS stated it could not back the waiver application "at this time."

Whenever states vote to expand Medicaid the federal government pays 90 to 100 percent of the program's expenses. If Arkansas were permitted to simply cover people up to 100 percent of poverty, the formerly enrolled members who lose their Medicaid coverage would be eligible for federal health insurance subsidies. This would shift the liability to pay healthcare expenses from the state to the federal government. This scenario is most likely not attractive to the Trump administration.

OTHER 1115 WAIVERS CURRENTLY PENDING

Work requirements for non-expansion states

Besides the denial of permitting lifetime limits on Medicaid enrollees, an additional component of Kansas' 1115 waiver application is still pending; namely, a work requirement. But unlike Arkansas, Indiana and Kentucky, Kansas didn't expand Medicaid by way of the Affordable Care Act (ACA); so demanding individuals to maintain an employment (minimally 80-hours per week) would most likely exclude them for the state's Medicaid program since they would be making too much money.

Oklahoma, Alabama, South Dakota and Mississippi are other states that didn't expand under the ACA exploring work requirements. The Center on Budget and Policy Priorities issued a report that highlights the catch-22 of these proposals.

In the state of Mississippi, for example, a single parent can not earn over $370 per month to receive Medicaid. Nonetheless, if they acquired 20-hour per week employment at minimum wage, they would earn $580 a month, which is too much income to qualify for Medicaid.

"They will be complying with the work requirement but still lose coverage. You're in this situation that can't be fixed," says Jessica Schubel, a senior policy analyst for the Center on Budget and Policy Priorities.

CMS' Verma has stated that she is concerned about this "subsidy cliff" and wants to find a "pragmatic and empathetic" approach to work requirements and other new Medicaid initiatives.

Drug testing for Medicaid enrollment

Finally, last year Wisconsin was the first state to ask for authorization to drug test Medicaid applicants allowing the denial of enrollment if they test positive. Specialists say that there is no way to tell where the federal government will decide the issue. Having said that, CMS has indicated that they would advocate the use of Medicaid funds to cover neonatal abstinence syndrome (a withdrawal ailment that takes place when an infant is born with an opioid addiction from their mother's use during pregnancy). Medicaid experts say it is hypocritical for the federal government to cover babies with drug-related problems but not their parents.

Click here and learn more. 

MEDICAID SCORECARD INTRODUCED BY CMS TO ASSESS PROGRAM'S ADMINISTRATION

The Center for Medicare and Medicaid Services recently released a Medicaid Scorecard to improve transparency and accountability. The scorecard contains care quality data from 2015 statistics provided by participating states, in addition to federally reported information. By combining this data, CMS and the states look to evaluate the performance of Medicaid plans, the program's administration, and outcomes. Any effort to improve efficiencies within the Medicaid program is met with unanimous support across the country; however, industry experts are concerned with the quality of the data used and the underlying purpose of the Medicaid Scorecard.

CMS's preliminary Medicaid scorecard intends to improve state and federal alignment, beneficiary health outcomes, and program administration. It functions to analyze how effectively states are delivering health services to their beneficiaries; at the same time, it takes a look at the timespan it takes for the federal government to authorize waiver requests from the states. The Medicaid Scorecard focuses on three particular areas of measurement:

• State Health System Performance measures "how states serve Medicaid and CHIP beneficiaries across key domains."

• State Administrative Accountability provides "insight into how states and the federal government work together to administer Medicaid and the Children's Health Insurance Program (CHIP).".

• Federal Administrative Accountability provides "insight into how the federal government and states work together to administer Medicaid and the Children's Health Insurance Program (CHIP).".

The Chief of CMS, Seema Verma, views the scorecard as a means of improved accessibility to Medicaid data and the program's care outcomes. Verma declared, "This is about bringing a level of transparency and accountability to the Medicaid program that we have never had before." Over time, CMS says it will make updates to the Medicaid Scorecard enabling it to address additional issues.

The National Association of Medicaid Directors (NAMD) has raised concerns. According to NAMD, "There are significant methodological issues with the underlying data, including completeness, timeliness, and quality." They call into question the quality of the data and what conclusions can be made from it. In their point of view, the data itself is out of date, rendering it an unreliable source to identify a state's performance. Additionally, they point out that any determinations made from the scorecard will be problematic since it compares states with significantly different Medicaid structures.

The Association for Community Affiliated Plans (ACAP) is encouraged by the introduction of a Medicaid Scorecard but also recognizes inconsistencies. The groups CEO, Margaret Murray, sees CMS's initiative as a good start. Murray shared, "we agree with Administrator Verma's note that this is a beginning in terms of how we talk about quality, rather than an endpoint. For one thing, the draft scorecard brings into sharp relief the need for more uniform, consistent data reporting across the Medicaid program."

CMS has recently issued their Medicaid Scorecard with hopes to improve state and federal alignment, beneficiary health outcomes, and program administration; however, Industry experts are calling into question its methodology.

Discover more Medicaid news here.

VIRGINIA LEGISLATURE APPROVES MEDICAID EXPANSION, NOW EYES TURN TO UTAH, IDAHO, NEBRASKA AND MONTANA

After months of deliberation among Republican representatives in both the House and Senate, lawmakers in Virginia voted in support of Medicaid expansion under the ACA on May 30th, 2018. The provision to expand the state's Medicaid program to over 400,000 Virginia citizens was included in the General Assembly's approved budget. Democratic Governor, Ralph Northam signed the bill at the state's capital on June 7th. Virginia will fund the expansion with the aid of a 90% funding from the federal government. According to The Commonwealth Institute, "The new Medicaid coverage would require state contributions totaling $1.02 billion over eight years, resulting in a net savings to the state of $1.06 billion."

The ruling to expand was motivated by two contributing factors. First and foremost, last November, the Republicans were at risk of losing their majority rule due to their resistance to Medicaid expansion. Second, Virginia's growing uninsured population is a strain on the state's ability to provide healthcare to its residents. Since the Affordable Care Act was introduced, the uninsured population has expanded as a result of increasing costs for coverage. Proponents feel that Medicaid expansion will strengthen Virginia's health care system and benefit both program members and people with private insurance. However, critics are worried about the related costs and sustainability of expanding the program.

The vote for Medicaid expansion in Virginia is encouraging news for supporters of other states around the country looking to expand their programs. At the moment, there are four states debating the issue.

Utah - In spite of support from lawmakers for a partial expansion, activists in Utah pulled together the required number of signatures to have a full expansion of Medicaid on the state's November ballot. At this time, polls suggest that over half of the state's voters back expansion.

Idaho - According to healthcare advocates, activists in Idaho have accumulated the required signatures for a ballot initiative. The initiative would allow residents to vote in November on a expansion of the states Medicaid program. At the time of this post, the signatures have been submitted to county clerk's for confirmation by June 30th.

Nebraska - Supporters of expansion in Nebraska have been collecting signatures since April for the Insure the Good Life petition. They will need 85,000 signatures from registered voters by July 5th in order to vote on the matter in November's general election. According to groups collecting signatures, momentum is on the side of Medicaid expansion for Nebraska.

Montana - Montana's Medicaid program is wanting to extend their expansion since it is set to expire in 2019. In order to fund the expansion, a ballot initiative requiring 25,000 signatures has been authorized by the Secretary of State. Unlike other efforts, Montana proposes an increase on taxing tobacco by $2.00 a pack alongside a 33% increase of the wholesale price for tobacco products. At this time, proponents are promoting the initiative and securing signatures.

As Virginia neared its first government shutdown, recently legislatures finalized a state budget that incorporated Medicaid expansion. 400,000 residents will now be eligible to enroll in the program. The choice to expand the program, despite resistance from Republican leadership, could be a good indication as to what will occur in other states seeking to expand this year.

Click here to learn more.