Arkansas: State Issues Public Notice of Intent to Extend Medicaid Expansion Program

The Department of Human Services notified the public of its intent to submit an 1115 waiver extension application to CMS to continue the State's Medicaid expansion program past its current end date of December 31, 2016. According to the draft extension application, which is open to public comment through December, the Medicaid expansion program (known as the "Private Option") has produced "positive outcomes" in Arkansas, including the nation's largest decrease in uninsured rates, large reductions in uncompensated care costs, and a positive impact on premium rates in the State's individual Marketplace. The State plans to submit a waiver amendment application in spring 2016, which may incorporate initiatives currently being considered by the Arkansas Health Reform Legislative Task Force, including enhanced cost sharing for the new adult group, measures to promote employer sponsored insurance, and a work referral program.

Indiana: Governor Requests Termination of Federal Medicaid Waiver Evaluation

Governor Mike Pence (R) requested that CMS terminate its federal evaluation of the State's Healthy Indiana Plan (HIP) 2.0 waiver demonstration, which expanded Medicaid through a health savings account-like model. As a condition of the waiver's approval, the State contracted with a vendor to conduct an independent evaluation of the demonstration. CMS contracted with a separate vendor to oversee the State evaluation and two other contractors to conduct a separate evaluation of the demonstration. In a letter to Secretary Burwell, the Governor expressed concerns about objectivity and conflicts of interest among the federal vendors and that two independent evaluations may produce conflicting results.

Kentucky: Senate Leadership Takes a Pass on Medicaid Expansion

Republican legislative leaders said they will not interfere with the State's Medicaid expansion program despite the Legislature's opportunity to halt the program by blocking funding, and will instead leave the program's fate in the hands of Governor-elect Matt Bevin (R). The State's expansion program, which was established by Governor Steve Beshear (D) through executive order, was fully funded by the federal government through 2016, so the Legislature was unable to defund the program and the Senate's alternative attempts to prevent expansion at that time were unsuccessful. Governor-elect Bevin has indicated that he will maintain expansion, but will introduce significant changes to encourage "personal and financial responsibility."

Louisiana: Senate Finance Committee Commissions Medicaid Expansion Report

In Monday's Senate Finance Committee session, legislators requested a report from the Louisiana Department of Health and Hospitals (DHH) outlining the State's options for expanding Medicaid, including potential customization through an 1115 waiver. The report, due January 1, 2016, will update a March 2013 report by DHH that analyzed potential costs and savings from Medicaid expansion. Governor Bobby Jindal (R) has staunchly opposed Medicaid expansion, but Governor-elect John Bel Edwards (D) has listed it among his top priorities, favoring traditional expansion that does not require an 1115 waiver.

Virginia: Hospital Association Supports "Provider Contributions" to Fund Medicaid Expansion

The Virginia Hospital and Healthcare Association (VHHA) sent a letter to Governor Terry McAuliffe (D) stating its conditional support for a "provider contribution" as a Medicaid expansion funding mechanism, a reversal of VHHA's longstanding opposition to such a mechanism. VHHA's conditions include among others: (1) the provider contribution program be administered and implemented by the private sector to the extent possible; (2) protections against fund diversions to other parts of the State budget; and (3) any savings generated by the program go to assist financially struggling rural hospitals. VHHA President Sean Connaughton said support for provider contributions was driven by "the mounting financial burden of diminished reimbursements, increased uncompensated care, and federal funding cuts." VHHA has been running an advertising campaign since September to convince lawmakers to expand healthcare coverage and Governor McAuliffe has made Medicaid expansion a priority for his administration. In response to the letter, Republican legislative leaders reiterated they will block any attempt by the Governor to expand Medicaid.

Wyoming: Governor Includes Medicaid Expansion in Budget Proposal

Governor Matt Mead (R) released a two-year, $3.5 billion budget calling for the Legislature to expand Medicaid and cut funds to a number of State programs to cover a budget shortfall caused, in part, by an anticipated decline in oil, natural gas and coal revenues over the next three years. Although the Legislature has historically opposed expanding Medicaid, doing so would bring the State roughly $268 million in additional federal funds. The Legislature will convene in early February to consider the Governor's recommendations and vote on a budget.