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January 2016 St@teside

Medicaid in 2016: What's Ahead for States?

It is 2016, and the New Year has already seen several states expanding and adapting their Medicaid programs. Some of these changes come on the heels of elections that brought new leadership into Governors’ offices. On just his second day in office, Louisiana Governor John Bel Edwards issued an executive order expanding Medicaid, fulfilling his campaign promise and making his state the first in the Deep South to do so. The expansion, set to take effect by July 1, is anticipated to cover an additional 300,000 people in addition to the 1.4 million already covered.

Another southern state, Kentucky, also elected a new Governor this year. Governor Matt Bevin, citing financial sustainability concerns, has stated he intends to alter the state’s current expansion and move to a model more closely resembling Indiana’s approach by 2017. Former Governor Steve Beshear had expanded Medicaid via executive order, and since 2014 Kentucky has enrolled nearly 500,000 people in the program. (Governor Bevin has also promised to shut down Kynect, the successful state-based marketplace through which the majority of Medicaid applicants enrolled.)

Meanwhile, Montana received permission from the Centers for Medicare and Medicaid Services (CMS) last year to move forward with its expansion and started covering residents on January 1. The approved waiver allows a third party administrator (Blue Cross Blue Shield) to provide services to newly eligible individuals. Michigan also recently had a new waiver approved by CMS that will allow the state to continue covering approximately 600,000 residents that have enrolled since the initial expansion took effect in 2014.

Other states are moving forward with transformation efforts aimed at reducing costs or improving efficiency. Iowa, which previously expanded Medicaid, is moving to “modernize” its program by moving most enrollees into managed care plans beginning on March 1, 2016. Though it has not expanded to cover additional residents, North Carolina plans to submit a waiver request to CMS by mid-2016 to similarly introduce managed care into its Medicaid program.

So far, 31 states and the District of Columbia have expanded Medicaid and talks continue in Virginia and South Dakota. As the year progresses, watch for more states to consider how to best expand access to coverage for more residents.