Louisiana: Administration Moving Ahead With Medicaid Expansion

On his second day in office, Governor John Bel Edwards (D) issued an executive order moving the Medicaid expansion in Louisiana forward with an effective date of implementation no later than July 1, 2016. The Executive Order highlights the federal dollars that have been foregone by Louisiana by not having expanded as well as anticipated General Fund savings that the state expects as a result of expansion. In his first week in office, the Governor and Secretary of the Department of Health and Hospitals (DHH) Rebekah Gee also met with CMS officials and are reported to be optimistic about working through the matters that will require federal approval in time for a July 1 implementation.

Vermont: Governor's Final Budget Proposal Aims to Close Medicaid Funding Gap

Governor Peter Shumlin (D) presented his sixth and final budget proposal to the State Legislature, highlighting his plan to cover Medicaid costs and close a $68 million budget gap by increasing revenue without raising income or sales taxes for Vermont's residents. Governor Shumlin proposed paying for Medicaid largely through a new 2.35% provider tax on physicians and dentists not affiliated with a hospital (there is an existing 6% provider tax on hospitals and affiliated physicians). Revenue from this source would generate an estimated $17 million in State funds, resulting in an additional $20 million in federal funds, which would be used to increase Medicaid reimbursements for primary and dental care. Of note, Governor Shumlin's initial proposal included an estimated $2.25 million in savings from decreasing Medicaid eligibility for pregnant women from 213% of the federal poverty level (FPL) to 138% of the FPL. The Governor rescinded that portion of his proposal less than 24 hours after the announcement, citing the potential negative health impacts on the population.

Wyoming: Committee Votes to Remove Medicaid Expansion From Governor's Proposed Budget

The Wyoming Legislature's Joint Appropriations Committee voted seven to five to remove Medicaid expansion from the 2017-2018 budget proposed by Governor Matt Mead (R). Governor Mead's administration estimated that expansion could extend coverage to over 20,000 Wyoming residents while saving the State's general fund approximately $33.4 million over the next two years. Inclusion of Medicaid expansion in the State budget was considered the best chance for expansion legislation to pass this year, though the Legislature could still consider a stand-alone bill or budget amendment during the legislative session.

CMS Releases Final Rule on Medicaid Covered Outpatient Drugs

CMS's recent final rule provides detailed guidance on implementation of several Affordable Care Act provisions regarding the financing of Medicaid covered outpatient drugs including: the calculation of Federal Upper Limits; the definition of the Average Manufacturer Price; and drug sales that are subject to rebates and those rebate amounts. While the ACA provisions became effective on October 1, 2010 and a proposed rule elaborated on them in February 2012, this final rule largely consists of new definitions for already existing concepts and provide detailed guidance on implementation. The final rule, which is likely to have an impact on many drugs' prices paid for many drugs, is effective April 1, 2016; however, three provisions become effective April 1, 2017 following states' submission of State Plan Amendments (SPA). States will need to comply with setting aggregate upper limits for certain drugs, comprehensively describe the payment methodology for prescription drugs, and delineate the process for assuring that changes in prescription drug payments satisfy statutory and regulatory requirements.