Big Week for Medicaid Expansion; Obstacles Ahead

May 31, 2018

Gorman Health Group
Olga Walther

There was quite a bit of activity in Medicaid expansion efforts this week, with remarkable strides made. In case you had trouble keeping up with all the news, here is a rundown of the biggest developments.

Virginia

The Virginia legislature approved a budget that would cover as many as 400,000 eligible people. The bill now goes to Governor Northam, a big proponent of expansion, for signature. The expansion does come at a cost, because the agreement states Virginia will have to submit a waiver to the Department of Health and Human Services (HHS) to impose work requirements and cost sharing on beneficiaries by 2020. Expansion efforts combatted a last-minute lobbying surge in which Rick Santorum and the Koch brothers laid the heat on the Republicans siding with the Democrats to expand. Ultimately, four GOP senators sided with the Democrats to narrowly pass the bill.

Idaho & Utah

Idaho officially confirmed expansion proponents gathered enough signatures for expansion to appear in election this year. The Lt. Governor of Utah also announced Medicaid expansion is officially on the November ballot. These efforts follow the success of Maine’s referendum last year in which voters overwhelmingly said yes to Medicaid expansion.

Maine

Speaking of the Pine Tree State, Superior Court Judge Michaela Murphy Thursday heard arguments in a case designed to force the LePage administration to implement the Medicaid expansion law voters approved in November. The plaintiffs argue the administration is attempting to effectively veto the expansion that was voted into law, while the administration argues it would go along with expansion once the legislature appropriates funding for the program.

During arguments, Murphy stated Gov. Paul LePage’s administration has a “duty to enforce” a voter-passed law to expand Medicaid to low-income adults. This commentary could be promising to expansion supporters.

California

Taking it up a notch, California’s General Assembly passed a bill to extend Medicaid coverage to immigrants, regardless of their status. The bill, if passed by the Senate and signed into law, would eliminate residency requirements for Medi-Cal. The cost of the proposal is $3 billion for the 2019 fiscal year.

Medicaid Cost Sharing Rule

Despite all the successful expansion efforts, we may see some obstacles ahead for the Medicaid program. HHS’ spring regulatory agenda, for example, includes a Medicaid cost sharing proposed regulation, slated for release in December 2018. Sources tell us this regulation comes as part of a request by the administration to explore cost sharing flexibilities in Medicaid. We have not seen changes to the cost sharing regulation in many years, and this would represent another step the administration is taking to adopt some conservative principles via proposed rulemaking rather than Congressional action or state waivers.

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