Positive Results Seen in Expansion States

In recognition of Medicaid’s 50th anniversary, the most recent Health Affairs publication included several analyses of the quality, cost, and utilization of care in three Medicaid expansion states—Ohio, Connecticut, and California. Taken together, the studies addressed oft-cited concerns about Medicaid expansion, such as the impact on health outcomes and increased use of services, particularly of the emergency room. A study in Ohio demonstrated that previously uninsured individuals in a waiver program with patient centered medical homes had significantly improved health between 2012 and 2013 compared to their uninsured counterparts; additionally, program costs were 29% below the expected budget. A study of the Health Care Coverage Initiative in California, which required previously uninsured patients to receive care from an individual primary care provider (PCP), found that enforcing this policy resulted in increased PCP visits and reduced emergency room visits and hospitalizations. One study in Connecticut, which expanded Medicaid in 2010, found that between 2010-2013 its level of uncompensated care was about one-third lower than it would have been without expansion, based on a comparison with other northeastern states during that period.

Alaska: Budget Prohibits Medicaid Expansion, Governor Continues to Consider Options

Though Governor Bill Walker (I) signed a State budget that prohibits appropriated funds to be used for Medicaid expansion, the Governor told reporters that he continues to weigh his options on Medicaid expansion, and his spokesperson announced that he would lay out his Medicaid expansion plans this Thursday, reports the Alaska Dispatch News. At the request of Governor Walker and legislators, respectively, Alaska’s Department of Law and Legislative Affairs Agency reviewed the Medicaid provision and found that the restriction may violate the confinement clause in the Alaska constitution because it could have the effect of amending existing law. Some Democratic legislators have urged the Governor to convene a special legislative session in the fall to consider Medicaid expansion.

Montana: Medicaid Expansion Waiver Seeks Premiums, Third Party Administrator

Montana’s Health and Economic Livelihood Partnership (HELP) Program waiver application, now posted by the State for public comment, requests permission to contract with a third party administrator for the delivery of and payment for healthcare services for most of the new adult population up to 138% of the federal poverty line (FPL), a mechanism not used in any other state’s expansion. Additionally, the State requests permission to impose monthly premiums equal to 2% of annual income and disenroll participants with incomes above 100% of the FPL who fail to pay. The waiver also seeks 12 month continuous eligibility for new adults.

Rhode Island: Medicaid Working Group Final Report Recommends DSRIP Waiver

The Working Group to Reinvent Medicaid, established through Executive Order in February, issued its second and final report to Governor Gina Raimondo (D) this week identifying 10 strategic goals for Rhode Island’s Medicaid system and recommending Rhode Island seek federal funds through a Delivery System Reform Incentive Program (DSRIP) 1115 waiver to support the creation of “integrated provider organizations that will be responsible for the total cost of care and healthcare quality and outcomes of an attributed population.” The strategic goals include paying providers based on the quality of services rather than volume; coordinating medical, behavioral, and long-term care; and shifting Medicaid spending from high-cost institutional settings to community-based providers. Governor Raimondo’s 2016 budget, signed in June, included many reforms suggested in the Working Group’s first report released in May.

Utah: Medicaid Expansion Negotiations Pended Until 2016

After several months of behind-closed-doors negotiations between Governor Gary Herbert (R) and legislative leaders, the working group announced it will not strike a deal on Medicaid expansion this legislative session. The working group hopes to introduce a compromise plan next year, after the 2016 legislative session opens in January.