Category: MM Curator

MM Curator summary

Texas AG has filed a request to stop the Biden administration from un-approving the 1115 DSRIP waiver.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Attorney General Ken Paxton sought a preliminary injunction to enjoin the Biden Administration’s illegal action rescinding the extension of the Medicaid Section 1115 waiver negotiated between Texas and the federal government. In a politically motivated move, the administration reversed its agreement to extend that waiver until 2030.   

“In an abuse of power, the Biden Administration blatantly ignored the needs of Texans when it revoked our Medicaid waiver,” Attorney General Paxton said. “Not only does this violate agency regulations, it was clearly intended to force our state into expanding Medicaid under the Patient Protection and Affordable Care Act. This flippant decision is illegal and cruel. Putting the lives of vulnerable Texans on the line for political gain is reprehensible.” 

After taking office, and acting through the Centers for Medicare and Medicaid Services, the Biden Administration purported to revoke that extension, with no warning to Texas. This will cause irreparable harm to Texans. 

Read the motion here.  

Clipped from: https://www.einnews.com/pr_news/546740767/pax-ton-seeks-pre-lim-i-nary-injunc-tion-after-biden-admin-is-tra-tion-ille-gal-ly-revoked-med-ic-aid-waiver

MM Curator summary

Arkansas’ reworked waiver will not require work to be covered, but will require it to get a managed care plan.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Arkansas submitted to the federal government on Tuesday a proposal to overhaul its Medicaid expansion after the program’s previous requirement that some recipients work was blocked by the courts.

The state Department of Human Services turned in its proposed waiver for the expansion program, and officials have said they hope to win approval by November or December.

As with the current program, the overhauled expansion would continue using Medicaid funds to place recipients on private health insurance. It also includes incentives aimed at encouraging participants to work or meet certain health goals.

Arkansas unveiled the proposal after the Biden administration moved to roll back Medicaid work requirements in Arkansas and several other states. A federal judge blocked the Arkansas work requirement.

Clipped from: https://www.modernhealthcare.com/medicaid/arkansas-submits-plan-overhauling-medicaid-expansion

MM Curator summary

The Missouri Supreme Court has heard all arguments and is expected to announce a decision soon.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

After an eight-year fight over Medicaid expansion, the arguments are over. The question of whether 275,000 people will receive state-paid health care coverage is in the hands of the Missouri Supreme Court.

Oral arguments took place Tuesday in an expedited appeal. The seven judges must decide whether Medicaid eligibility will expand, as directed by the constitutional amendment approved by voters, or, as Cole County Judge Jon Beetem ruled, if it was fatally flawed because it did not include a new source of revenue to pay the anticipated costs.

The court’s only other option, suggested by Attorney General Eric Schmitt’s office in its final written brief, is to leave people eligible for coverage without actually providing it unless lawmakers explicitly fund it.

While there is no deadline for the decision, the expedited schedule indicates the court will rule soon, because coverage was supposed to start July 1.

“What is at stake here is life-saving health care,” Joel Ferber, director of advocacy for Legal Services of Eastern Missouri said to reporters after oral arguments concluded. “Our lead plaintiffs and our clients are desperate for the health care they need.”

In the days and hours leading up to the oral arguments, the judges received plenty of advice on how they should rule. The final written arguments from Schmitt’s office, which wants the court to uphold Beetem, were filed Friday. Friend-of-the-court briefs, along with the final filings from the plaintiffs seeking an order in favor of expansion, were being filed as late as Monday afternoon.

The court, however, heard only from John Sauer, representing the state, and Chuck Hatfield, representing three women who sued when Gov. Mike Parson announced the state would not open enrollment for the expansion group.

Amendment 2, passed last August opened Medicaid eligibility to adults ages 19 to 64 who earn less than 138 percent of the federal poverty guideline. Sauer told the court that while that group is eligible, lawmakers control state spending and did not make room for them in the budget.

“Their intent was not to fund the expansion population and only fund the pre-expansion population,” Sauer said.

Reading the same appropriation bills, Hatfield found a different interpretation. While the spending bills didn’t include the estimated $1.9 billion to cover the expansion population, he said there is money for every service available under Medicaid and there are options to control spending that would provide coverage for everyone eligible.

“The legislature must, of course, follow the priorities the people put in the constitution,” Hatfield said.

The path from passage of the Affordable Care Act in 2010, with a requirement that states expand Medicaid coverage, to Tuesday’s arguments, has been dominated by politics, with Democrats and their supporters pushing the state to go along and Republicans just as strongly resisting.

Then-Gov. Jay Nixon first asked lawmakers to expand coverage in 2013, but here was never a realistic chance the Republican-dominated General Assembly would go along.

Passage of Amendment changed some minds, but not enough. Parson, who opposed Amendment 2, put money for the anticipated costs in his January budget proposal. When the final vote on funding came in May in the Missouri Senate, only four Republicans joined 10 Democrats in support of Parson’s request.

Since 1945, the Missouri Constitution has prohibited initiatives that require appropriations if the same ballot measure does not generate the needed revenue. That is why Beetem ruled Amendment 2 is invalid, writing that because it requires the state to spend money, it is unconstitutional.

“How is it you can look back on an election that is past and decide it is invalid?” Judge W. Brent Powell asked Sauer. “How long can you continue to do that?”

“That is not our argument,” Sauer replied.

In his brief for the state, Sauer of the attorney general’s office argued that the judges have only two choices – find that Amendment 2 is valid but subject to appropriation, or that it was not validly enacted.

“This conflict is real, and it stubbornly resists plaintiffs’ belated attempts to explain it away,” Sauer wrote.

Last year, the court decided lawmakers could not use appropriation bills to make Planned Parenthood ineligible to provide Medicaid-paid family planning services. Sauer asked the court to overturn that decision and allow lawmakers to determine which legally eligible people will and will not receive Medicaid coverage.

The judges don’t have to stretch logic that far, Hatfield argued. The three women who initiated the lawsuit are eligible, the legislature appropriated money for every service provided by Medicaid and therefore they cannot be denied, the attorneys wrote.

“This court has consistently held that every doubt, and every ambiguity, should be resolved in favor of upholding the will of the people,” Hatfield said.

The governor has various methods to control spending and though some may be painful, the options are real, Hatfield said Tuesday.

In the brief filed Monday, Hatfield and his co-counsels in the case wrote that the program’s cost, whether for traditional Medicaid or the expansion population, is uncertain every year, they wrote.

First, no one has any idea whether the amount of money the General Assembly appropriated is too much, not enough, or just right, they wrote. “The number of enrollees in the MO HealthNet program fluctuates from year to year, as do the quantity and types of services used.”

The amicus curiae, or friend of the court, briefs have come in from conservative groups, health care providers, backers of Amendment 2 and lawmakers. There’s even a secondary dispute, with Missouri House Democratic Leader Crystal Quade of Springfield and Assistant Democratic Leader Richard Brown of Kansas City asking the court to reject, or at least ignore, the brief filed in the name of the full House.

The stakes are enormous, both for those who would receive coverage and for the state’s treasury.

In the brief for the state’s 12 Federally Qualified Health Care Centers, which serve 600,000 patients, Jim Layton, formerly the state’s top appellate attorney, wrote that it is essential that the clinics serve paying patients to support their work for those without insurance.

Of the people using them, he wrote, 46 percent are on Medicaid already and another 25 percent are without insurance. Many of the uninsured would receive coverage, he wrote, and lawmakers funded all services provided by Medicaid.

“But the General Assembly cannot, merely by changing a dollar figure in a line of an appropriation bill, change a parameter of the program that was constitutionally defined by the people by initiative, any more than it can, by changing a dollar figure or including a proviso in an appropriations bill, change eligibility for any other program,” he wrote.

Before passage of Amendment 2, Missouri was one of 14 states that had not yet expanded Medicaid under the 2010 Affordable Care Act. The law originally made expansion mandatory but the U.S. Supreme Court ruled in 2012 that penalty provisions that made Medicaid an all-or-nothing program were unenforceable.

Under the terms of the ACA, states pay 10 percent of the cost of expansion and the federal government covers 90 percent. In the traditional Medicaid program, Missouri pays about 35 percent of the cost.

Amendment 2 extended coverage to people aged 19 to 65 with household incomes less than 138 percent of the federal poverty guideline, or $17,774 a year for a single person and $36,570 for a household of four.

Under the current Medicaid program, adults without children are not eligible unless they are blind, have another qualifying disability or are pregnant.

The traditional Medicaid program is expected to cost about $12 billion in the current fiscal year.

In his January budget proposal, Parson estimated the total cost of expansion at $1.9 billion, with $130 million from general revenue, $1.65 billion from the federal treasury and the remainder from taxes on medical providers.

If Missouri does expand Medicaid coverage, it will become eligible for additional support for the traditional program estimated to save the state $1.2 billion over two years.

Clipped from: https://www.columbiamissourian.com/news/state_news/fate-of-missouri-medicaid-expansion-in-the-hands-of-the-state-supreme-court/article_96a01070-e5b6-11eb-963d-b7dcec94d387.html

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US Congressmen are introducing a bill to sell Medicaid on the exchanges for free in holdout states.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Sen. Raphael Warnock, D-Ga., speaks at Alfred E. Beach High School in Savannah, Ga., Thursday, July 8, 2021. Warnock joined fellow Democratic senators Jon Ossoff of Georgia and Tammy Baldwin of Wisconsin in introducing a bill on Monday, July 12, 2021, to require the federal government to set up a Medicaid-like health plan in states that have not expanded Medicaid plans to cover more low-income adults. (Jim Watson/Pool via AP)

Jim Watsdon

ATLANTA (AP) — Three Democratic U.S. senators from states that have refused to expand Medicaid want the federal government to set up a mirror plan to provide health insurance coverage to people in those states.

Sens. Raphael Warnock and Jon Ossoff of Georgia and Tammy Baldwin of Wisconsin are introducing the bill Monday, they told The Associated Press. Congressional Democrats are pushing for a coverage expansion in upcoming legislation.

“The single most effective solution to closing our state’s coverage gap is to expand Medicaid,” Warnock said after a June 29 meeting with health care executives. “What we ought to be doing is expanding Medicaid rather than playing games with the health care of Georgia citizens.”

The effort is crucial for Warnock, who seeks reelection in 2022 facing several Republicans eager to defeat him.

People making more than 138% of the federal poverty level are eligible for federal health insurance subsidies through an online marketplace. But as many as 4 million people who make less don’t get assistance in a “coverage gap,” according to the Kaiser Family Foundation.

President Barack Obama’s Affordable Care Act envisioned states would expand Medicaid programs to cover those people, but many conservative states balked. There are 12 holdouts, while an expansion in Missouri mandated by referendum is in limbo after Republican lawmakers refused to pay for it.

Democrats increasingly say leaving people without coverage is unacceptable. They tried to lure remaining states with two years of extra money for expansion, but none budged. Baldwin said such a refusal is “just wrong.”

“Our legislation will open the door to those who have been shut out and expand access to affordable health care, including preventive care, that people want and need,” she said in a statement.

The bill would mandate a new health insurance plan that looks just like Medicaid offered to residents in holdout states. President Joe Biden proposed during his campaign to offer a public option through the federal healthcare marketplace. Democratic Rep. Lloyd Doggett of Texas and others introduced a bill June 17 to let local governments create local Medicaid expansions.

The Medicaid approach has key advantages, said Jesse Cross-Call, director of state Medicaid strategy with the liberal-leaning Center for Budget and Policy Priorities.

The plan would require no premiums and only small copayments, while those costs can be much higher for individuals on the marketplace. People can enroll in Medicaid year-round, while marketplace enrollment is typically only in the fall, or when someone’s circumstances change.

“The idea is for it to be as close to Medicaid coverage as possible,” Cross-Call said.

A new plan could take years to set up, though. Many states use managed care networks to provide Medicaid services, and it’s unclear if the federal government would be able to contract with the groups.

Sponsors say coverage is already paid for because the original Affordable Care Act included money for all 50 states. States normally shoulder 10% of the cost, but the bill would require no state contributions.

The plan also would boost incentives for holdout states to expand on their own. It would raise the federal share of state-federal Medicaid spending by 10 percentage points this coming decade. The current enticement, included in Biden’s coronavirus relief bill, is 5 percentage points for two years. Based on Kaiser Family Foundation estimates, that could be worth a cumulative $160 billion to holdout states and Oklahoma, which launched expansion July 1.

Republicans, Warnock said in June, are effectively “standing between Georgia voters and their tax dollars that are still being paid to cover Medicaid in other states.”

Republicans aren’t backing down. Georgia Gov. Brian Kemp is pursuing a limited expansion that would impose work or education requirements for benefits. It seeks to add 50,000 Georgia residents in its first two years and require everyone to shop for federally subsidized insurance through private agents. The Biden administration is reevaluating previous approval of the plan by the Trump administration, a reversal Kemp says isn’t allowed.

“The Biden administration has been, in my opinion, trying to throw up roadblocks to our waiver plan that was approved,” Kemp recently told AP. “Senator Warnock can hit me all he wants on Medicaid. What he never mentions is … working on lowering costs for private sector health care. A lot of people don’t want government health care.”

Financial incentives could be required to keep other states from dropping Medicaid expansion to avoid current costs. The bill doesn’t address that.

Warnock spokesperson Meredith Brasher reaffirmed that sponsors want the measure attached to any budget reconciliation measure Democrats use to advance educational and social welfare priorities through the Senate without Republican support.

“Recovery legislation presents a unique, historic opportunity to close the gaps in coverage for the millions of people in the Medicaid coverage gap,” wrote more than 60 members of the Congressional Black, Hispanic and Asian Pacific American caucuses on June 16.

——Clipped from: https://www.pressrepublican.com/news/senators-seek-medicaid-like-plan-to-cover-holdout-states/article_0d7e832b-a349-59d1-a7d3-38a1fa65abdd.html