Arkansas: Governor Introduces Medicaid Expansion and Managed Care Bills

Governor Asa Hutchinson (R) introduced draft legislation to renew the State's Medicaid expansion beyond its December 2016 expiration date. The Governor's plan, called "Arkansas Works," proposes mandatory premium assistance for beneficiaries with access to cost-effective employer-sponsored insurance, a work referral program, and premiums for beneficiaries with incomes above 100% of FPL. At the same time, the Governor and legislators introduced competing bills regarding managing high-risk Medicaid populations. Governor Hutchinson introduced a bill to transition certain high-risk populations and services from the State's traditional Medicaid program to full-risk managed care while legislators introduced a managed fee-for-service initiative, in which a third party vendor manages administrative tasks such as independent assessments, prior authorization, and outcome measurement. Lawmakers will consider the Medicaid expansion and managed care proposals at a special legislative session set to begin April 6.

Alabama: Governor Vetoes Budget Citing Inadequate Medicaid Funding

Governor Robert Bentley (R) vetoed the State Legislature's General Fund budget, saying that its insufficient Medicaid funding puts existing services at risk and makes the State's recently approved Medicaid reform efforts unsustainable. The Medicaid agency received $85 million less than the $785 million that was requested. Legislative leaders said they expect to override the veto, while Governor Bentley has said he may call a special session to address Medicaid funding. Last year, it took the Governor and the Legislature six months and two special sessions to agree on a budget that ultimately kept Medicaid funding level after earlier proposals to cut agency funding by $156 million.

Idaho: Legislature Votes Down Proposal to Extend Medicaid to "Gap" Population

The House voted on the last day of the legislative session to reject the Senate's proposal to extend Medicaid coverage to the estimated 78,000 uninsured Idahoans in the coverage gap, those who earn too much to qualify for Medicaid but too little to qualify for federal tax subsidies on the Marketplace. The proposal would have required the Department of Health and Welfare to seek a federal waiver to implement a managed care program for the "gap" population. As a partial expansion, the proposal would not have been eligible for the enhanced federal funding. Despite Democratic pleas, Governor C.L. "Butch" Otter (R) said he will not hold a special session to address the issue, nor will he use executive authority to intervene. He will, however, support the bipartisan legislative committee that is slated to study the issue over the summer. The Republican House Speaker says the goal is to develop a proposal to provide health insurance to individuals in the coverage gap prior to the 2017 legislative session.

New Mexico: Wide-Ranging Cost-Cutting Measures for Medicaid Under Consideration

The State's Medicaid Advisory Committee has been tasked with developing recommendations for implementing cuts to the Department of Human Services' budget, which was signed into law by the Governor in an attempt to close a nearly $417 million shortfall. The budget requires reductions in provider reimbursement rates and Medicaid managed care administration costs, as well as establishing cost sharing for Medicaid beneficiaries, including co-payments for certain services and monthly premiums. The bill also "assumes the department may be required to consider" changes to the amount, duration, and scope of Medicaid benefits and enhancements to eligibility verifications. While the Human Services Department Secretary indicated that implementing the scope of these cuts will be an "insurmountable" task, he recently outlined progressmade by the Medicaid Advisory Committee's working groups on the program changes. The committees will produce recommendations on provider cuts as early as April 2016, and is targeting January 2017 for changes to benefits, co-payments, and eligibility verifications, and a waiver request if needed.

Rhode Island: State Projects $75 Million in Medicaid Savings This Year

Medicaid reforms enacted based on recommendations made by Governor Gina Raimondo's (D) Working Group to Reinvent Medicaid are projected to save the State $75 million in Medicaid spending this year and nearly $120 million in fiscal year 2017, according to a progress report released by the State Medicaid agency. The report notes that while Medicaid enrollment is projected to grow by more than 2.5% between 2015 and 2017, per member per month costs have declined by 4.4%, which the State largely attributes to "payment reforms that reward providers for better coordination and better outcomes." The report was released in conjunction with a new Reinventing Medicaid proposal for fiscal year 2017 that seeks to expand on existing reform initiatives. Specifically, the new proposal aims to reduce managed care administrative expenses, better integrate long-term care for seniors, increase commercial insurance contributions to a fund that covers services for children with special needs, and prepare the State to launch a new phase of the State's health infrastructure project.