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February 2015 St@teside

The Medicaid (R)evolution?

President Barack Obama met with governors earlier this week to discuss Medicaid, indicating interest to work with those states that have not yet elected to expand the program to do so in collaboration with the administration. Prior to that meeting, however, there has been a flurry of activity in many states looking to expand Medicaid. The catch? Many of these states are negotiating expansions that push the boundaries of what is considered ‘traditional’ Medicaid.  

For example, in late January, The Centers for Medicare and Medicaid Services (CMS) announced the approval of Indiana’s expansion – Healthy Indiana Plan 2.0. Among the new provisions included in the HIP waiver, individuals with incomes above the federal poverty level will be disenrolled from coverage for not making monthly premium payments to their health savings account and will be unable to re-enroll for six months. Additionally, individuals will have an option to receive assistance to buy employer-sponsored coverage. All individuals enrolled in HIP 2.0 will be charged an $8 copay for the first non-emergent visit to an emergency room and a $25 copay for each subsequent non-emergent visit. The plan also offers job training and job search programs.

Other alternative Medicaid expansion plans have been introduced or are being considered in several states including Alaska, Montana, Tennessee, and Utah, with some having greater likelihoods of getting the nod from their state legislatures than others. As usual, politics remain the major obstacle as has been seen in efforts in Kansas and Wyoming that have been rejected. Interestingly enough, Pennsylvania, which received approval from CMS for its alternative Medicaid plan under former Republican Governor Tom Corbett, is now in the process of moving towards implementing a traditional Medicaid program under the leadership of Democrat Governor Tom Wolf, who was sworn into office earlier this month.  

2015 will be a fascinating year as we watch the development and approval of new Medicaid expansion plans. CMS has already garnered attention with the approval of Indiana’s expansion plan.  Which state(s) will be next? And how will they seek to get political will to be able to move forward with an expansion?