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May 2015 St@teside

Montana Joins the Medicaid Expansion States; Who's Next?

Montana is the latest state to join those that have opted to expand Medicaid, with Governor Steve Bullock signing the expansion bill – Montana Health and Livelihood Economic Partnership (HELP) Act – into law on April 29. Montana’s Department of Public Health and Human Services will contract with a third party administrator to implement the expansion, which no other expansion state has done before. The HELP Act requires new enrollees to pay copayments in addition to premiums of 2 percent of their monthly income. Also through the HELP Act, Montana has appropriated funds for a voluntary workforce development program for new enrollees.

The passing of the HELP Act has made Montana the 30th state, including DC, to expand Medicaidunder the Affordable Care Act. With Medicaid expansion having been in effect for more than a year, there is a growing body of evidence demonstrating the positive impacts of expansion. A recent report from the State Health Reform Assistance Network showed that eight states—Arkansas, Colorado, Kentucky, Michigan, New Mexico, Oregon, Washington, West Virginia—achieved $1.8 billion in budget savings by the end of 2015 as a result of Medicaid expansion. Furthermore, Michigan has released data capturing the impact of its expansion program on promoting health behaviors among beneficiaries, with Healthy Michigan Plan resulting in more than 344,000 primary care visits, 116,000 preventive care visits, 35,000 mammograms, and 17,000 colonoscopies.

Some states also have begun reporting on the expansion’s impact on uninsured patients’ hospital utilization. For instance, this report from the New Hampshire Hospital Association shows that, in the first nine months of New Hampshire expanding Medicaid, hospitals in New Hampshire have seen the number of emergency room visits by uninsured patients drop by 22 percent, as compared to the 17 percent reduction in uninsured emergency room visits that hospitals experienced in 2014. They have also experienced a 27 percent reduction in inpatient admissions and 15 percent reduction in outpatient visits of uninsured patients.

Thus, it comes as no surprise that the Medicaid expansion debate is ongoing in some of the remaining non-expansion states as they continue to weigh the benefits of expanding coverage against the budgetary, political, and market implications of implementing expansion. Here is the latest from these ongoing debates:

  • Alaska: Governor Bill Walker had been continuing to push for Medicaid expansion; however, his expansion bill was stalled in the legislature, with the House Finance Committee stating it would not move forward with the proposal and the Senate refusing to hold any hearings on Medicaid expansion during the special session.
  • Florida: Governor Rick Scott and the legislature’s debate over Medicaid expansion and the costs of uncompensated care pool programs led to its legislative session ending without an approved budget. In the midst of this debate, Governor Scott elevated the debate by suggesting that the state was being coerced to expand Medicaid because CMS was withholding funding for its Low-Income Pool program. However, CMS has recently signaled that it is willing to compromise on a plan that would provide funds to reimburse hospitals for treating uninsured patients, but the cost would have to be shared by the federal government and the state. Thus, we’re likely to see more on this debate during the legislature’s special session, which begins on June 1.
  • Louisiana: While Louisiana’s current governor, Bobby Jindal, has been a staunch opponent of Medicaid expansion, he is not able to run for re-election in the next year. In an effort to keep the possibility of Medicaid expansion alive when a new governor takes office, the Louisiana House voted in support of a financing mechanism to pay for the expansion, if expansion was implemented by April 2016.