Alabama: Legislature Overrides Budget Veto, Medicaid Prescription Drug Benefit Targeted

Governor Robert Bentley (R) and State Medicaid Commissioner Stephanie Azar announced several potential changes to the Medicaid program a day after the Legislature overrode the Governor's budget veto, effectively funding Medicaid by $85 million less than requested. Governor Bentley and Azar said the budget's underfunding of Medicaid could halt the State's transition to managed care delivered through Regional Care Organizations if the budget goes into effect as is on October 1. They also said the State may have to forfeit federal funds provided under a recently approved 1115 waiver to support that transition. Governor Bentley and Azar identified several potential changes to the Medicaid program in response to the budget shortfall, including: eliminating prescription drug coverage for adults ($50-$60 million in savings); requiring all enrollees fill prescriptions through a single "big box" pharmacy ($19-$30 million in savings); reducing provider reimbursement rates for primary care ($15 million in savings); and eliminating coverage for eyeglasses, outpatient dialysis, prosthetics and orthotics ($5 million in savings). A joint legislativesubcommittee will hold hearings on Medicaid funding next week. Any reduction in Medicaid benefits would require federal approval.

Arkansas: Governor Signs Medicaid Expansion Renewal, Legislature to Consider Funding This Week

Governor Asa Hutchinson (R) signed legislation to extend and reform the State's Medicaid expansion after the Legislature approved the measure last week. The legislature must now provide funding for the plan, called "Arkansas Works," by a three-fourths majority during this week's legislative fiscal session. Separately, HHS Secretary Sylvia Burwell said the federal government will continue to work with Arkansas on waiver approval for Arkansas Works, though Burwell said the State would need to make additional improvements to its Medicaid eligibility and enrollment system for CMS to approve the State's request to eliminate 90-day retroactive coverage for the expansion group.

Iowa: House Republicans Propose Oversight for Newly Implemented Medicaid Managed Care

House Republicans proposed an oversight plan for the managed care organizations (MCOs) in the State's Medicaid managed care program, which went into effect on April 1. The plan would require MCOs to publicly report on enrollment, health outcomes, access to care, and program integrity. The Senate approved a separate Medicaid oversight bill in March that would create a legislative oversight committee and a fund to collect savings realized from managed care. Governor Terry Branstad (R) and Senate Democratic leaders said they would work with the House to develop consensus legislation on MCO oversight.

Louisiana: Provider Opposition Stalls Medicaid Expansion Copay Proposals

Three bills to require copays for Medicaid expansion members, including a bipartisan proposal supported by Governor John Bel Edwards (D), werewithdrawn from consideration during a hearing of the House Health and Welfare Committee following opposition testimony. The bill supported by Governor Edwards would have imposed an up to $8 per visit fee for non-emergency care in the emergency room and for "non-preferred" prescription drugs. Opposition to the proposals was led by the Louisiana Hospital Association, which released a statement indicating that Medicaid copays are "uncollectable" and a "huge administrative burden." Representative Jack McFarland (R) indicated after the hearing that he will bring the copay bill back up for consideration before the end of the legislative session.

Texas: Higher Costs, Less Access for Low-Income Residents Compared to Other Southern Expansion States

Low-income Texans are less able to afford their medical bills, to cover the costs of prescription drugs, and to access consistent care for chronic conditions compared to their counterparts in southern states that expanded Medicaid, according to The Commonwealth Fund. In addition to its decision to not expand Medicaid, Texas chose not to develop an in-person assistance program to help consumers enroll in insurance, and it passed laws limiting community organizations' ability to fill that role. The report also found that Texans had less awareness of the ACA's coverage expansions; lower application rates for Medicaid or Marketplace coverage, and lower rates of application assistance from navigators or social workers among those who applied for coverage. Five million, or nearly one in five Texans, are uninsured—the highest level in the country.

Wisconsin: Concept Paper Proposes Integration of Medicaid Programs

The Department of Health Services (DHS) has finalized a concept paper on the redesign of the State's Medicaid long-term services and supports (LTSS) programs that would move more than 55,000 Medicaid beneficiaries receiving LTSS through the Family Care and Include, Respect, I Self Direct (IRIS) programs into "integrated health agencies." DHS was mandated to make a number of changes to these programs under Act 55 of the 2015-2017 State budget, including designing and implementing integrated health agencies to coordinate beneficiaries' LTSS, primary and acute care, and behavioral health care. The final concept paper was submitted to the Legislature's Joint Committee on Finance on March 31 for final approval following a series of public hearings. If approved, DHS will seek a federal waiver or Medicaid State Plan Amendment.