Legislative Council Drops Medicaid Expansion Lawsuit

The joint legislative council that sued Governor Bill Walker (I) over his executive order expanding Medicaid voted to drop its lawsuit after Superior Court Judge Frank Pfiffner ruled that the House could not substitute itself as the plaintiff in the case. The council's vote effectively ends the lawsuit. Pfiffner dismissed the lawsuit last March, ruling that Governor Walker had the authority to expand Medicaid without legislative approval. More than 19,000 individuals have gained Medicaid coverage since the expansion took effect last September.


Joint Legislative Committee Will Consider Options for Medicaid “Gap” Population

The newly-established “Healthcare Alternatives for Citizens Below 100 Percent of Poverty Level” committee reviewed earlier attempts to expand coverage in Idaho during its inaugural meeting. The committee was established on the final day of the previous legislative session as the House voted down a measure to extend coverage to an estimated 78,000 Idahoans in the “coverage gap,” those who earn too much to qualify for Medicaid but too little for federal tax subsidies on the Marketplace. Committee co-chairs plan to bring coverage recommendations to the 2017 Legislature, which may include a federal waiver request to receive enhanced federal matching funds. CMS has not approved waiver requests for enhanced matching funds for coverage expansions that do not include all eligible individuals earning up to 138% of FPL.


Preliminary Reports Evaluate First Year of Healthy Indiana Plan 2.0

Nearly three-fourths of those eligible for the Healthy Indiana Plan (HIP) 2.0 enrolled for at least one month during the first year (approximately 408,000 individuals), according to a State-commissioned program evaluation. The report comes as CMS conducts a separate evaluation of HIP 2.0’s impact on enrollees. HIP 2.0 (the Medicaid expansion program) offers a "Basic" plan to members below 100% of FPL and a "Plus" plan to all enrollees that requires members pay into a Personal Wellness and Responsibility (POWER) Account, which functions similarly to a health savings account. Plus plan enrollees earning below 100% of FPL who fail to make payments are automatically transitioned to the Basic plan. Those earning between 100% and 138% of FPL who fail to make payments are disenrolled from Plus coverage until payments are made. The report found that: over 90% of Plus enrollees made their required contributions to POWER accounts; approximately 8% of Plus members with incomes below 100% of FPL failed to make a payment and were transitioned to the Basic plan; and 6% of Plus members with incomes above 100% of FPL were disenrolled for failure to pay. Anthem’s Public Policy Institute separately released a white paper indicating that roughly 82% of all Plus members have incomes below 100% of FPL and therefore opted to pay for the enhanced coverage. Anthem is one of three HIP 2.0 issuers.


Survey Finds Uninsurance Rate Cut in Half, Partially Due to Medicaid Expansion

The uninsurance rate in Minnesota fell to an unprecedented 4.3% in 2015, down from 8.2% in 2013, according to the State Department of Health’s (DOH) semiannual Health Access Survey. The report notes that the most recent two percentage point increase in public coverage continues an overall 15-year upward trend and cites the Medicaid eligibility expansions in 2011 and 2014 as major contributors. Additionally, from 2013 to 2015 group coverage remained steady, ending yearly declines in group coverage since 2011. The most substantial coverage gains were among the “long-term uninsured,” those who had been uninsured one year or longer. In a presentation to the MNSure board (the State-based Marketplace), DOH noted that there are a number of individuals eligible for premium subsidies who are not receiving them, potentially due to people’s lack of awareness or confusion about their eligibility. DOH noted that as the uninsurance rate falls, those left without insurance can be harder to reach, hence the importance of targeted outreach efforts.


New Revenues and Savings Would Offset Most Medicaid Expansion Costs, Report Finds

A “considerable portion” of the cost of expanding Medicaid in Oklahoma would be offset by new revenues and cost savings generated by an expansion, according to a new report from Manatt Health commissioned by the Oklahoma Hospital Association. The report found that expansion would cost the State $739 million over five years though all but $196 million would be offset by savings and revenue including: increased availability of enhanced federal matching funds for current Medicaid enrollees ($301 million in savings); increased revenue from an existing 3% hospital assessment ($52 million in revenue); and lower general fund spending on uninsured care ($190 million in savings). Additional savings are possible due to CMS’ recent rule expanding the circumstances under which 100% federal funding is available for individuals who receive Medicaid services through the Indian Health Service (IHS). The new rule would lower the State’s cost of insuring both the expansion population and current Medicaid enrollees who access care through the IHS. The study’s findings also do not reflect the broader economic impact of expansion found in states that have expanded Medicaid, including job creation, and increased economic activity and tax revenue. The report estimates that 272,000 individuals would enroll in the new adult group under Medicaid expansion in 2019 after a “ramp-up” period.


Task Force Proposes Phased Medicaid Expansion

The Legislature’s health care task force has proposed expanding Medicaid to individuals with incomes up to 138% of FPL in two stages: first to military veterans and individuals with mental illness or substance abuse disorders, then to all individuals. The new program would include: a health savings account and “healthy behavior” incentives; sliding scale premiums and coverage lock-outs for failure to pay; an employment and education assistance program; and transition assistance for enrollees moving to private coverage as their incomes increase beyond 138% of FPL. The second phase of the expansion would be contingent on the success of the first phase, based on metrics that may include costs per member, enrollment levels, health outcomes and emergency room utilization. Task force chairman Cameron Sexton (R) said he expects there will be several months of negotiations with the federal government prior to presenting the proposal to the Legislature.

National News

Five Million Uninsured Would Gain Eligibility if Remaining States Expanded Medicaid in 2017

The Urban Institute estimates that 4.8 million uninsured individuals would become eligible for Medicaid if the 19 states that have not yet expanded Medicaid opted to do so in 2017; an additional 8.6 million insured individuals would also become Medicaid-eligible. More than half of the currently uninsured who would become eligible live in three states: Texas, Florida, and Georgia. The vast majority—more than 80%—are adult nonparents and nearly half are white non-Hispanic. Nationwide, there would be between 7.8 million and 8.8 million new Medicaid enrollees, assuming an enrollment rate between 70% (a “moderate” rate) and 88% (a “high” rate).

Report Details Medicaid Strategies for Combating Opioid Addiction Epidemic, Including Expansion

A new report from the Robert Wood Johnson Foundation and Manatt Health details the role Medicaid can play in fighting the nationwide opioid epidemic and finds that Medicaid is “the most powerful vehicle” states have to fund and deliver treatment and prevention services for opioid addiction, particularly for states that have expanded Medicaid. Individuals eligible for Medicaid expansion coverage—largely single adults not traditionally covered prior to the ACA—have a higher prevalence of substance use disorders (SUDs) than those eligible for traditional Medicaid and, in expansion states, these adults receive the ACA’s 10 essential health benefits, including SUD services. Expansion states can rely on Medicaid funds to cover the cost of prevention and treatment, while non-expansion states are forced to rely on limited state general funds to assist uninsured adults. The report presents a variety of strategies that states can use—both through traditional and expanded Medicaid—to prevent and treat opioid use disorders and other SUDs, including tailoring benefit designs, implementing Health Homes targeted towards individuals with SUDs, and leveraging Medicaid’s purchasing power to expand use of best practices in SUD prevention and treatment. The report also details how states can use 1115 waivers to draw down additional federal funding to transform the payment and delivery of SUD services.