State Medicaid Agencies Continue to Improve Eligibility and Enrollment Processes

The Kaiser Family Foundation's 14th annual 50-state survey on Medicaid and CHIP eligibility and enrollment finds that states continued to improve and streamline their Medicaid enrollment and renewal processes in 2015, noting that all but one state now accept applications online and all but two accept telephonic applications. The report also finds that 34 states' eligibility systems can process automated Medicaid renewals, and 47 states are now up-to-date with renewing enrollees. A number of states made enrolling easier for children and pregnant women by, for example, eliminating waiting periods and expanding CHIP to state employees' dependents. Thirty-seven states reported the capacity to make Medicaid eligibility determinations for low-income children, pregnant women, and non-disabled adults within 24 hours; of the 27 states tracking the percentage of applicants that can be processed in this timeframe, 11 reported a rate of 50% or more. The report also notes that coordination between state Medicaid agencies and the Marketplaces remains a challenge, despite improvement in 2015.

Alaska: Reports Highlight Benefits of Medicaid Expansion and Propose Medicaid Reforms

report commissioned by the State Legislature analyzing Medicaid expansion dismissed many of the concerns raised by State lawmakers who oppose Alaska's expansion, established by Governor Bill Walker (I) via executive order. The authors find that expansion would lead to a net gain of $170 million annually for the State. The report also notes that expansion would not trigger a significant increase in non-expansion Medicaid enrollment (the so-called woodwork effect) and that such increases are more directly related to ACA implementation than Medicaid expansion. Oral arguments in the Legislature's lawsuit against the Governor's action begin this week. A separate report commissioned by the State Department of Health and Social Services (DHSS) made recommendations for Medicaid reform including: moving towards a payment model that rewards outcomes and efficiency; paying providers a per-patient care coordination fee; linking providers to each other and to a prescription drug database; and establishing accountable care organizations. Governor Walker's administration incorporated the DHHS report's recommendations into a revised Medicaid reform bill, which will be reviewed by a recently established Medicaid reform Senate subcommittee.

Kansas: Twin Medicaid Expansion Bills Introduced, Futures Remain Unclear

Legislators in the House Federal and State Affairs Committee and its Senate counterpart have introduced identical bills for a Medicaid expansion plan, "Bridge to a Healthy Kansas," crafted by the Kansas Hospital Association (KHA) and modeled after Indiana's expansion program. The plan would extend coverage to approximately 150,000 Kansas residents through KanCare, the State's Medicaid managed care program, and require enrollees above the federal poverty level to make monthly contributions up to 2% of income towards a personal healthcare account. Enrollees would lose coverage if they failed to pay. All non-disabled unemployed adults or those working less than 20 hours per week would be referred to State workforce training and job search resources. While the Legislature and Governor Sam Brownback (R) have historically opposed expansion, the Governor reportedly indicated a willingness to consider a Medicaid expansion program if it met certain requirements, including budget neutrality.

Michigan: Governor Seeks Medicaid Eligibility for Flint Residents up to Age 21

Governor Rick Snyder (R) will seek federal approval to extend Medicaid coverage to Flint, Michigan residents up to age 21, regardless of income or enrollment status in other insurance programs, amid the unfolding water crisis there. The Governor is also calling for increased community-based resources, including physical and behavioral health treatment, long-term healthcare services typically needed by children exposed to lead, and federal Medicaid match for lead abatement actions in impacted areas. State officials have indicated that the cost of the proposals are unknown, and details have not been released regarding the impact on long-term Medicaid eligibility.

Virginia: State Submits $1 Billion Medicaid DSRIP Waiver

The Department of Medical Assistance Services submitted an 1115 Medicaid waiver application to CMS requesting authority to implement a Delivery System Reform Incentive Payment (DSRIP) program and Medicaid Managed Long-Term Services and Supports (MLTSS) for dual eligible enrollees. The $1 billion DSRIP initiative would establish networks of "high performing providers," known as "Virginia Integration Partners" (VIPs), that would share and integrate patient care, data, processes, and communication. VIPs would also partner with managed care organizations to coordinate care and transition to new payment models for high-cost Medicaid enrollees. In demonstration year three, additional providers, known as "Affiliate Providers," would transition to alternative payment models for individuals not receiving care through a VIP. The MLTSS initiative would expand an existing care coordination demonstration for high-risk dual eligibles statewide.