Arizona: State Seeks Increased Cost-Sharing, Coverage Restrictions for Medicaid Expansion Population

Arizona Governor Doug Ducey (R) submitted a section 1115 Medicaid Waiver application describing the “AHCCCS CARE” Medicaid expansion program, which requires enrollees to pay up to 5% of income across co-payment and premium charges. Co-pays, capped at 3% of income, are paid monthly for services already obtained, including for services such as missed appointments, accessing specialists without a referral, and using brand name drugs when a generic is available to “strategically…steer members to the right care at the right setting.” Enrollees are also charged up to 2% of income (or $25 per month, whichever is less) as a monthly premium, which is deposited into an HSA-like “AHCCCS Care Account” to fund services not already covered, such as dental and vision. To use the Care Account, enrollees must have made timely payments, met at least one “healthy target” metric, and participated in an employment support or job training program administered by the Department of Economic Security. Failure to make these payments would result in disenrollment for six months for those with incomes over 100% FPL, while it would be considered a debt to the State for those with incomes under 100% FPL. The Waiver also proposes a number of delivery system reforms, including a Delivery System Reform Incentive Payment (DSRIP) model built on provider network accountability and a program to improve the quality of and access to care for the American Indian/Alaskan Native populations. If approved, the new Waiver would begin October 1, 2016 and run through September 2021.

Louisiana: Gubernatorial Candidates All in Favor of Medicaid Expansion

All four candidates on the ballot to replace staunch Medicaid expansion opponent Governor Bobby Jindal (R) expressed their support for Medicaid expansion during a televised debate, according to local media. Each of the three Republican candidates cited the State's financial deficit as a factor in their consideration of expansion, and said they would request a CMS waiver to pursue alternative expansion options. The Democratic candidate said he would pursue traditional expansion early in his term. The gubernatorial election will be held on October 24, with a runoff election on November 21 if no candidate receives a majority of votes. In June 2015, the State Legislature passed a new hospital assessment, supported by the Louisiana Hospital Association, that would help to fund the non-federal share of the expansion’s costs should the new governor expand Medicaid by April 2016.

Tennessee: Report Shows Decreased Uninsured Rates

report released by the University of Tennessee Center for Business and Economic Research analyzing insurance status and use of medical facilities found that the State’s overall uninsured rate has continued its downward trend since 2013, now having fallen to 6.6%—the lowest rate in over a decade. The uninsured rate for children has also dropped to 1.5%, a full percentage point decrease since last year. Nine out of ten families that remain uninsured cited affordability as the main barrier to coverage. The report also found that 94% of TennCare—the State’s Medicaid program—head-of-households first sought care at a doctor’s office or clinic, as opposed to an emergency room, up from 90% in 2014. Lastly, 95% of TennCare beneficiaries remain either “somewhat satisfied” or “very satisfied” with the program’s quality of care; the satisfaction level has remained constant for a decade.

Utah: Latest Medicaid Expansion Plan Rejected

Utah House Republicans voted 56-7 against the latest Medicaid expansion plan “UtahAccess+”—just revealed publically last week—forcing the State Legislature back to the drawing board. According to House Speaker Greg Hughes (R), UtahAccess+ failed to gain enough support due to concerns about funding sustainability, growing costs, and active opposition from the provider community who opposed the use of provider fees to finance the State’s share. Just one day after this rejection, a different coverage expansion framework emerged from Governor Gary Herbert (R) and legislative leaders that focused more narrowly on extending coverage to uninsured, medically frail individuals under 100% FPL. A partial expansion would make Utah responsible for the State’s standard 30% of the program’s total costs instead of the enhanced match available for a full Medicaid expansion.