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Size of Medicaid Expansion Influenced Administrative Spending

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[ MM Curator Summary]: States that had more room to grow (ie had higher uninsurance rates) benefitted more when they expanded (in terms of administrative costs), likely due to economies of scale and handing over more scope to MCOs.


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.




States that enacted Medicaid expansion and had high uninsurance rates among low-income residents were considered large expansion states and subsequently saw a slight decrease in administrative spending.


Source: Getty Images


By Victoria Bailey

November 30, 2021 – Medicaid expansion did not impact overall administrative spending, but states with large expansions saw slight reductions in spending while smaller expansions led to minor increases, according to a Health Affairs report.

Administrative spending covers expenditures for eligibility and enrollment assessments and processes, interagency costs, claims processing, information technology systems, and more. States did not receive reimbursement for administrative costs following Medicaid expansion, and there is little research that speaks to whether expansion impacted this spending.

Researchers from Indiana University gathered data from all fifty states and focused on two outcomes in each state: the percentage of total spending that was administrative and per enrollee administrative spending.

State expansion, spending, and enrollment data from 2007 to 2017 were obtained through various CMS and Kaiser Family Foundation (KFF) reports.

The Health Affairs report looks at the differences in administrative spending between states that have expanded Medicaid and nonexpansion states. Additionally, the researchers compared large expansion states to small expansion states and states that expanded Medicaid traditionally through the Affordable Care Act to states that used Section 1115 to expand their program through waivers.

Researchers classified expansions as large or small by using the median uninsurance rate among nonelderly adults who had incomes below 100 percent of the federal poverty level in the year before the expansion. If the uninsurance rate was high, expansions were considered large.

Medicaid expansion became optional for states in 2014. Since then, 38 states and Washington DC have expanded their Medicaid programs.

Prior to 2014, expansion and nonexpansion states had similar levels of administrative spending, but most expansion states saw a larger unadjusted decline in per enrollee administrative spending after expanding their programs, researchers found.

The average annual per enrollee administrative spending in nonexpansion states before 2014 was slightly more than $444. Between 2014 and 2017, it fell to a little over $408, signifying a $35.60 decrease.

States that underwent large expansions saw a $106 annual decrease, going from an average of $507 per enrollee administrative spending pre-2014 to $401 between 2014 and 2017. States that had small expansions saw a slighter decrease of $20.99.

The adjusted analysis revealed very few differences in per enrollee administrative spending for nonexpansion and expansion states, including states that used ACA expansion methods and ones that expanded through waivers.

When categorizing Medicaid expansion states by expansion size, the differences were slightly more apparent. States that had large expansions saw a significant decrease in per enrollee administrative spending of $77 compared to nonexpansion states, while states with small expansions saw a nonsignificant increase compared to nonexpansion states.

In looking at the percentage of total spending that is administrative, researchers found similar results. Large expansion states had a nonsignificant reduction compared to nonexpansion states. Meanwhile, small expansion states had a significant increase in the percentage of spending that was administrative compared to nonexpansion states.

Overall, Medicaid expansion did not significantly escalate administrative spending for expansion states. But when considering expansion sizes, small expansions led to slight increases in administrative spending.

“States with larger expansions may experience economies of scale, where it becomes less expensive and they become more efficient as more people are enrolled in the program,” the report stated.

Additionally, states with larger expansions are known to have stricter eligibility criteria and may spend less on Medicaid overall, according to the researchers.

Small expansion states may have seen increases in administrative spending due to differences in reimbursement rates, application requirements, and eligibility and enrollment processes. States with smaller expansions also tend to have more generous Medicaid programs, which could exhibit higher spending, the report noted.

Twelve states have yet to expand Medicaid, barring access to healthcare coverage for many of their residents. Most of these states have high uninsurance rates and low eligibility thresholds which would lead to large expansions, researchers said. According to the study results, these expansions would increase coverage access while also reducing administrative spending.

The American Rescue Plan Act is encouraging states to expand Medicaid as well by offering an increase in federal medical assistance percentages (FMAP) for the first two years after expansion.


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South Dakotans will vote on Medicaid expansion in 2022, pending petition validation

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The state hospital association has gathered enough signatures for its version of the voter Medicaid expansion ballot initiative.


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.


PBS NewsHour

Voters will decide whether to expand Medicaid to more low-income South Dakotans as long as the secretary of state verifies enough petition signatures were turned in on Monday.

South Dakotans Decide Healthcare said it turned in 46,119 signatures from registered South Dakota voters. That’s more than the 33,921-signature threshold needed for initiated constitutional amendments to be placed on the November 2022 ballot.

The number “really shows the grassroots energy and excitement around this,” said spokesman Zach Marcus.

South Dakotans Decide Healthcare was the only group to turn in its proposed ballot question ahead of Monday’s deadline for initiated constitutional amendments. Initiated measures have a later deadline.

Medicaid is a federal-state health insurance program for low-income people. South Dakota is one of 12 states that has not accepted federal incentives to expand Medicaid eligibility, according to the Kaiser Family Foundation.

Medicaid expansion has only failed once when put before voters, according to Health Affairs. Voters in Maine, Idaho, Utah, Nebraska, Oklahoma and Missouri approved expansion. Montanans rejected expansion — which would have been covered through a tobacco tax increase — but lawmakers later approved it.


The South Dakota amendment would expand Medicaid to people between 18 and 65 who earn 133% or less of the federal poverty level.

Expansion would make Medicaid available to 42,500 additional South Dakotans in its first year, according to the non-partisan Legislative Research Council.

Studies show Medicaid expansion improves healthcare outcomes while producing economic benefits for recipients, healthcare systems and the overall economy.

Medicaid expansion faces a challenge after the Legislature voted in 2020 to refer a constitutional amendment to the voters during the June 2022 election — before the Medicaid vote in November 2022.

The proposed amendment says any ballot question that raises taxes or spends at least $10 million — such as the Medicaid expansion question — must be approved by 60%, not 50%, of the voters.

Sen. Lee Schoenbeck, R-Watertown, supports the amendment.


Schoenbeck “acknowledged that his expedited push was motivated by the Medicaid expansion campaign, but argued the vote threshold should apply to all ballot initiatives that levy taxes or spend significant state funds,” according to the Associated Press.

Expansion supporters are concerned about voter turnout in the June election since it’s a primary election without a presidential race. Just 26% of South Dakota voters participated in the June 2018 election compared to 65% in November.

“When we educate voters on why this is going to be helpful for South Dakota, when we educate voters on why this matters and will help them and their families, South Dakota voters respond to this,” Marcus said. “So if we need to get 60% of the vote for this to pass, that’s what we’ll do.”

South Dakotans Decide Healthcare is a statewide ballot question committee that raised $21,639 by the start of 2021, records show. Donors include the AARP, Farmers Union, healthcare organizations and the Fairness Project, a D.C.-based social and economic justice nonprofit.

Proposed initiated amendments that won’t be on the ballot addressed redistricting and elections. Those groups did not turn in petitions Monday, according to the secretary of state. A proposed initiated measure for recreational marijuana and an initiated measure that also addresses Medicaid expansion have a May 3 deadline.


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Oklahoma- Hospital officials don’t want to pay for Medicaid expansion

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Oklahoma hospitals are not as supportive of Medicaid expansion now that they won’t make as much money off of it.


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.



Oklahoma hospitals were among the most prominent supporters of State Question 802, which expanded the state’s Medicaid program to include many able-bodied adults starting July 2021.

But now, only months after the expansion took effect, hospital officials say they don’t want to pay the Supplemental Hospital Offset Payment Program (SHOPP) fee that partially covers the state cost of expansion, and instead urged state lawmakers to divert other tax collections away from other uses to subsidize hospitals.

“In the discussions we’ve had out here with many of you over the past two years, a lot has changed, and we always came to talking with you—in Medicaid-expansion terms—to say hospitals would like to be the payer of last resort,” said Patti Davis, president of the Oklahoma Hospital Association.

“Our whole purpose in asking for this was to say, ‘What can we do to help reduce that SHOPP assessment?'” said Jimmy Durant, director of government affairs for SSM St. Anthony.

Hospital officials made their pitch during a recent study conducted by members of the Senate Appropriations Committee.

Under the Medicaid expansion authorized by the federal Affordable Care Act, better known as “Obamacare,” the federal government matches $9 for every $1 in state tax funding provided to cover expansion.

Advocates of expansion, which included hospitals, argued the state cost was negligible and that “free” federal money would more than offset any state expense.

Hospital officials also lobbied the Oklahoma Legislature to enact the SHOPP fee in 2011. The fee, assessed on nearly 70 hospitals’ revenue, is used to generate federal matching funds and boost hospitals’ Medicaid payments.

The Oklahoma Hospital Association supported creation of the SHOPP fee in 2011, and even declared that the SHOPP fee would “diminish the need for cost shifting” and that, because of the federal matching funds generated by the fee, SHOPP would “actually increase the income to hospitals.”

To cover the state cost of Medicaid expansion imposed by SQ 802, the SHOPP fee is scheduled to increase. The SHOPP fee rate is capped at a maximum of 4 percent and is currently 2.5 percent.

Figures presented by the Oklahoma Hospital Association showed that Medicaid expansion will dump $1.3 billion into the coffers of health providers this year, but officials claimed that hospitals will nonetheless struggle to pay an additional $37 million for the half-point increase in the SHOPP fee rate scheduled to take effect in 2022.

Davis noted 68 hospitals will be paying higher SHOPP fees in the years ahead to partially fund the state government cost of Medicaid expansion.

That’s $37 million for the first year. The next year that would double. And then the next year, it would be one-and-a-half times,” Davis said. “So, you can see why we’re interested in having this conversation.”

Durant said SSM officials anticipate paying $24 million to $25 million more in SHOPP fees over the next three years combined.

However, SSM hospitals are on pace to reap $36 million during that time via reduced write-offs because of Medicaid expansion, according to figures presented during the study. Durant said SSM’s three hospitals, which represent only a small share of all hospitals statewide, are seeing $1 million per month less in write-offs under expansion.

“Since expansion, have hospitals seen a benefit? And the answer to that, for our system, is absolutely,” Durant said. “We have seen less no-pay, write-offs.”

Hospital requests to offload their share of Medicaid-expansion costs come even as hospitals are seeing a huge inflow from federal COVID-bailout funding. Federal funding has provided certain hospitals between $50,000 and $77,000 per COVID-19 admission in the past year-and-a-half.

Davis conceded that Oklahoma hospitals “have received a lot of federal funding” for COVID expenses, but said “it has not been equal” so that “everyone was held harmless and no one has losses.”

“There’s a misnomer among the public that COVID, because hospitals are so full, that this has been a boon for hospitals,” Davis said. “Let me just say, first and foremost, COVID has been very hard on our members.”

She said some hospitals had “high COVID costs” and are now “in tough spots” financially despite the Medicaid expansion payments and federal COVID funding.

Durant said SSM requested the legislative study because SSM officials want state sales taxes collected on marijuana sales to be directed to cover the cost of Medicaid expansion instead of SHOPP fees.

In addition to the 7-percent excise tax on marijuana, which was part of the ballot measure that legalized the drug in Oklahoma, state government also collects sales tax on marijuana sales. Durant said much of the tax money generated by “medical” marijuana sales is not going to medical entities.

“Right now, the way it’s broken out, some of the money goes to the Education Reform Revolving Fund, teachers’ retirement, tourism-promotion fund,” Durant said. “If we’re going to address health care in the state of Oklahoma, and we’re going to have a tax on ‘medical’ marijuana, shouldn’t we use that money more for medical purposes than for maybe some of these other purposes?”

Durant said the state sales tax on marijuana would produce $35 million annually and that half of that amount could be used to replace hospital SHOPP fees. Senate staff indicated state sales-tax collections on marijuana may run as high as $42.5 million.

However, one lawmaker questioned whether the hospitals’ proposal would be popular with voters.

“Is your view that the designations that the people voted on — that specifically focused on common education — was solely for what was later interpreted as excise tax?” said Sen. Julia Kirt, D-Oklahoma City. “Because I sure know that when I was out meeting voters, they were very concerned about those funds going towards common education.”

The hospitals’ proposal also contrasts with promises those entities made when advocating for Medicaid expansion.

In a 2018 column, Davis declared, “The notion that expanding health care coverage would take money away from other areas, such as education, simply isn’t true.”

Ads for the “Yes on 802” campaign also promised that Medicaid expansion would result in a “more financially secure rural health care system” and “save rural hospitals.” But one rural lawmaker indicated the reality of Medicaid expansion has not lived up to the hype.

“After we redistrict, I’ll have almost 25 percent of the total state’s area. I’ve got more hospitals in my district than anyone,” said Sen. Casey Murdock, R-Felt. “And they’re all struggling.”


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Arkansas- Governor expects federal waiver approval for continuation of Medicaid expansion program

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The revised AR expansion waiver has back-pedaled its original design to include no requirements related to work, but still has different benefits for members who do not engage in their own health.


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.



HUTCHINSON (file photo) Asa Hutchinson

Governor Hutchinson said Tuesday at his press conference that he anticipates that the federal government will approve the state’s request to renew its Medicaid expansion program, with some revisions, prior to the end of the year, when the state’s current Medicaid expansion agreement expires.

The Medicaid expansion, authorized by the federal Affordable Care Act, covers adults who make less than 138 percent of the federal poverty level (an annual income of $17,774 for an individual or $36,570 for a family of four). The program in Arkansas, first enacted in 2014, uniquely uses Medicaid funds to pay for private health insurance to cover most beneficiaries. Once nicknamed the “private option” and now known as “Arkansas Works,” it was implemented under a series of agreements with the federal government, known as waivers because the feds waive certain Medicaid rules. The latest request, submitted this summer, renames the program ARHOME.

“We’ve been assured that they would act on that in sufficient time so the waiver doesn’t expire — which is the end of the year,” Hutchinson said. “So our [Department of Human Services] is working diligently with them on that. I don’t anticipate any issue in getting the new waiver granted. But that specific timeframe is undetermined.”

The new waiver request maintains the use of private health insurance to cover beneficiaries, but would route people who are “inactive” to the regular Medicaid program rather than the private plan. Under the state’s waiver request, it doesn’t take much to stay “active” — if beneficiaries simply choose their own plan as opposed to being auto-assigned, or if they go to the doctor for a checkup, they are considered active, even if they don’t participate in other incentive programs the state is planning (participating in one of those programs, which includes incentives to encourage employment, would also count). So long as they interact with the plan in some way — completing a health assessment, say, or any use of a medical service, etc. — they can stay in the private plan. In very early talks with lawmakers, the idea was floated of making incentives around work or education/training part of the requirement to keep a private plan. But the final framework only designates someone as inactive if they don’t do anything at all related to their health care plan. 

The ARHOME waiver also proposes an increase in premiums charged to most beneficiaries who make more than the poverty level. Beneficiaries would not lose coverage for failure to pay, but would incur a debt to the insurance companies (currently, those who fail to pay premiums incur a debt to the state, which can be withheld from tax refunds). Currently, most beneficiaries who make more than the poverty line are charged a flat $13 per month. The ARHOME waiver proposes bumping that up, depending on income:

Co-payments would also be higher, and would be applied to more beneficiaries. Currently, co-payments are only charged to beneficiaries who make more than the poverty line, and are capped at $60 per quarter. Under ARHOME, they would be charged at most income levels and the caps would be bumped up (see chart below). Failure to pay would incur a debt to the provider. No one would lose coverage for failure to pay. According to the waiver request, “A provider cannot refuse to provide service for non-payment at the first occurrence but can refuse to provide a future service due to non-payment.” Here are the proposed maximum annual allowable amounts on the co-pays by income:


Here are the co-pays that will be in place in 2022, according to the waiver proposal:


The total of both co-pays and premiums will be capped at 5 percent of household income per quarter.

Those deemed medically frail — and those routed in a new program for people with serious mental illness or substance use disorder — will not be charged premiums or co-pays.

The ARHOME program also includes new initiatives for rural health, maternal and infant health, behavioral health and certain at-risk populations. State officials focused on these initiatives when they unveiled the waiver request last summer.

ARHOME also includes wellness incentives programs, along with the work and education incentives programs, as well as mechanisms to contain cost growth and to establish quality performance targets for the private plans.

If the feds approve the ARHOME waiver, it could still come with minor variations to the framework not described in the request: Certain terms and conditions may apply that will provide more details about just how that framework will function in practice.


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Missouri: Close to 13,000 people have been enrolled in expanded Medicaid


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The uptake on MO expansion continues to be very low.


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.


Close to 13,000 people have been enrolled in expanded Medicaid in Missouri, according to the Department of Social Services.


Audio Player


In 2020, a majority of Missouri voters passed a ballot measure to expand the government-funded health insurance to about 275-thousand low-income adult residents. The benefits include primary and preventive care, emergency services, prescription drugs, and substance use disorder treatment. Through the American Rescue Plan, Missouri will be eligible to receive an estimated 968-million-dollars in additional federal funding for its Medicaid program over the next two years.


October 23, 2020

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KS- Gov. wants federal workaround for Medicaid expansion

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Kansas Governor is signaling support for the Medicaid expansion via exchange subsidies effort.


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.


TOPEKA –  Governor Laura Kelly sent a letter to Congressional leadership urging Congress to pass legislation that would create a Medicaid expansion work-around in non-expansion states, according to a media release from her office. Congress is currently in recess. The Senate returns to work next week and the House will return to work in two weeks.

Kansas is one of twelve states that has failed to expand Medicaid, and this political obstruction has prevented 165,000 Kansans from accessing quality, affordable health care,” said Governor Laura Kelly. “My administration will continue to fight for Medicaid expansion at the state level, but until then, this federal legislation will allow us to bypass the self-destructive politics pushed by the Republican leaders in the statehouse and bring resources, jobs, and life-saving health care to our state.”

Passing H.R. 4595, the Medicaid Saves Lives Act, or including similar provisions in the pending budget and reconciliation process, would allow eligible residents of non-expansion states like Kansas to access full Medicaid coverage at no additional cost to states or the federal government. Additionally, this legislation would increase federal medical assistance percentages by ten percent for states that expand Medicaid, providing states like Kansas ten years to access full funding if they choose to expand Medicaid at the state level.

Currently, Kansas is one of twelve states that has failed to expand Medicaid – despite overwhelming public approval and the predicted economic benefits, including:

  1. Adding nearly 23,000 new jobs in the state of Kansas;
  2. Creating $17 billion in economic output through 2025;
  3. Raising personal income by $6.3 billion; and
  4. Saving private-sector employers up to $80.6 million.

Additionally, Medicaid expansion in Kansas would:

  1. Provide affordable health care to 165,000 Kansans who currently fall into a health coverage gap – including 7,400 veterans and their spouses;
  2. Support Kansas’ rural hospitals and communities; and
  3. Enhance services for mental health and substance use disorders.

“The Medicaid Saves Lives Act is the chance Kansans have been waiting for. It’s the right thing to do to support our people, our communities, and our economy,” said Governor Laura Kelly.


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State funds for Oklahoma Medicaid expansion remain untouched

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OK now has $164M in a savings account it had planned on using for expansion but doesn’t need to because of enhanced COVID funding from CMS.


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.


OKLAHOMA CITY (AP) — The $164 million appropriated by the Oklahoma Legislature to pay for the state’s share of Medicaid expansion remains untouched in a state agency savings account, state legislators learned Monday.

Oklahoma Health Care Authority CEO Kevin Corbett told House and Senate members that the agency has used savings generated from the Medicaid expansion, along with enhanced federal COVID-19 relief funds for states, to pay for the expansion so far.

The savings were generated by shifting about 65,000 Oklahomans whose health care costs were previously funded through the state’s Insure Oklahoma plan or other sources to the expanded Medicaid population, where the federal government covers 90% of the costs.


Corbett told lawmakers an estimated 700 to 800 Oklahomans are qualifying each day for health coverage under Medicaid expansion, although he expects that number to slow down in the coming months. As of Monday, Corbett said about 170,000 people have qualified for Medicaid under the expansion. The Health Care Authority has projected about about 215,000 residents would qualify for expanded Medicaid, and Corbett says those projections are likely still accurate.

After a decade of Republican resistance to expansion in Oklahoma, voters narrowly approved a constitutional amendment last year to expand eligibility for benefits. Now, an individual who earns up to $17,796 annually, or $36,588 for a family of four, qualifies for Medicaid health care coverage. By contrast, the median income limit for parents in states that didn’t expand their program is about $8,905 for a family of three, according to the Kaiser Family Foundation.


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State to expand Medicaid eligibility following court ruling

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Medicaid expansion eligibles can apply for Medicaid in MO, but will have to submit expense reimbursement requests until the legislature actually funds the expansion.


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.


The Missouri Department of Social Services (DSS) will begin allowing individuals to apply for the MO HealthNet program under Article IV, Section 36(c) of the Missouri Constitution following an August 10 ruling by the Cole County Circuit Court.

Although the federal government began providing funding to expand Medicaid in 2014, Missouri is one of 13 states that had continued to reject Medicaid expansion. That will soon change as a result of a unanimous Missouri Supreme Court ruling that was issued in July 2021.

Missouri voters approved Medicaid Expansion in August 2020 by a vote of 53.25% to 46.75%. It required the state to submit a Medicaid expansion state plan amendment to the federal government by March 2021, and for Medicaid expansion to take effect by July 1, 2021.

However, when state lawmakers passed the 2022 fiscal year budget, they failed to include funding for the state’s portion of the cost of Medicaid expansion. Lawmakers did allocate normal funding for MO HealthNet, but the DSS indicated that it would not change the eligibility criteria for Medicaid coverage, since lawmakers had not expressly allocated funding for that purpose. The state withdrew the Medicaid expansion state plan amendment that it had submitted to HHS earlier in the year.

A lawsuit was brought by Missouri residents who would gain eligibility under the expansion. Missouri DSS argued that the ballot initiative was unconstitutional since the state constitution says ballot measures can’t be used to appropriate state funds. In June a circuit court judge ruled that Missouri’s Medicaid expansion ballot measure was unconstitutional because it didn’t include a funding mechanism.

The case was appealed, and the Missouri Supreme Court vacated the lower court’s ruling, and noted that the Medicaid expansion eligibility criteria outlined in Missouri Article IV, Section 36(c) are “now in effect.”

The ruling means that MO HealthNet eligibility must be expanded to include adults under age 65 with household incomes up to 138% of the poverty level. In 2021, that amounts to about $17,774 for a single individual, and $36,570 for a household of four – children are already eligible for Medicaid at higher income levels. Once implemented, this is expected to result in 275,000 Missouri residents becoming eligible for MO HealthNet.

The expansion amendment also legally requires the state to maximize federal funding. DSS will continue to work towards fulfilling the state’s legal obligations under the Constitution and court order, Parson announced following the ruling.

“My administration is always going to follow the law and yesterday’s court order is no exception,” Governor Mike Parson said Wednesday. “The necessary funding to cover the health care costs of the expanded population remains the issue. We will continue to work with the General Assembly and DSS to chart a path forward to comply with the court order and keep the MO HealthNet program solvent.”

The governor’s office said the required system update is anticipated to take up to 60 days, citing “staffing capacity and funding restraints.” The state is currently working through administrative hurdles, including adequate appropriations, staffing capacity, and computer software changes in order to begin enrolling the expanded population.

Governor Parson included funding in his FY22 budget proposal to the General Assembly to cover both the health care costs of the expanded population and for 75 additional employees to administer the expanded program. The proposed funds were not included in the final FY 22 budget. As a result, DSS is limited to administering the expanded MO HealthNet program without sufficient staffing or appropriations.

Missourians who believe they are eligible for MO HealthNet benefits under the expanded Medicaid eligibility may go to MyDSS.MO.Gov to apply. DSS will begin making eligibility determinations once MO HealthNet’s software is updated to reflect the court order. In order to comply with the court order and until the necessary funds can be appropriated, DSS will reassign existing employees from their current assignments and responsibilities in order to receive and evaluate MO HealthNet applications.

Qualifying health care costs that are incurred by eligible Missourians between the time they apply and when DSS is able to verify their eligibility may be reimbursed at a later date.

Healthcare for Missouri, a coalition that educated voters on the need to expand the state’s Medicaid eligibility requirements as prescribed in Amendment 2.

“We’re delighted that Judge Beetem has ruled that the State must begin enrollment immediately,” a statement from Healthcare for Missouri read. “Our coalition urges the State to take action and we stand ready to work with all involved to ensure Missourians’ ability to receive the medical care they deserve.”

Particularly at a time when the state is seeing an alarming increase in COVID cases and deaths, access to healthcare is lifesaving, vital, and past due, considering funding is already available, the organization said.

“State after state has shown that in addition to providing insurance to those eligible, expansion is a fiscal and economic boon to state economies and budgets,” according to the organization’s response. “Not only do states save money on existing health services, but federal funds from expansion create jobs and increase economic activity, generating additional tax revenue to fund the state’s share of expansion.”

In states that expand Medicaid, the federal government paid the full cost of expansion through 2016. Starting in 2017, the states gradually started to pay a share of the expansion cost, which will remain at 10%. From 2013 through 2022, Missouri was projected to give up $17.8 billion in federal funding by not expanding Medicaid.

The American Rescue Plan Act included additional funds to support states in expanding Medicaid. That incentive will provide Missouri with an additional $1.2 billion over the next two years to support the existing Medicaid program, freeing up state funds that can be used to support additional priorities.

“Hardworking Missourians like me have waited and waited for this,” said Nina Canaleo, a 38-year-old Kansas City mother with Multiple Sclerosis who will benefit from Medicaid expansion being fully and expeditiously implemented. “We deserve and need access to healthcare to care for ourselves, our families, and our communities. It’s time for the State to do its job so I can get back to doing mine.”

Until Medicaid expansion actually takes effect in Missouri, non-disabled adults without children are not eligible for MO HealthNet regardless of how low their income is, and parents with dependent children are only eligible with incomes that don’t exceed 22% of the poverty level. Only Texas and Alabama have lower Medicaid eligibility caps, at 18%.

According to insurance company IHC Specialty Benefits, 127,000 people remain in the coverage gap in Missouri, unable to qualify for Medicaid because the state still has not expanded eligibility for Medicaid coverage and unable to qualify for premium subsidies in the exchange/marketplace because they earn less than the poverty level. As of April 2020, 887,433 Missourians are covered by Medicaid/CHIP, and another 230,000 are expected to gain coverage.

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CMS extends deadlines for Medicaid redeterminations after COVID-19 public health emergency ends

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States now have 12 months (instead of 6) to conduct re-determination exercises once the PHE is declared over.


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.


Dive Brief:

  • CMS is extending the timeframe states have to complete pending verifications, redeterminations based on changes in circumstances and renewals for Medicaid, the Children’s Health Insurance Program and Basic Health Program beneficiaries after the federal public health emergency for COVID-19 ends, according to a Friday letter from the agency.
  • Due to significantly increased workloads, state health officials will now have 12 months instead of six after the PHE ends to complete those tasks. It doesn’t change the four-month timeframe after the PHE ends that they have to resume the timely processing of all applications, however.
  • The letter also does not confirm when the federal PHE will end, as it has been extended multiple times. CMS will provide additional detailed guidance on the updated policies in the coming months, it said.

Dive Insight:

Enrollment in Medicaid and CHIP has grown to a record high, with more than 81 million beneficiaries. That’s largely due to the Medicaid continuous enrollment requirement tied to pandemic relief legislation that ceased typical churn, according to the letter.

A disruption in operations caused by the pandemic and the continuous enrollment requirement mean states will be faced with high volumes of eligibility and enrollment actions they’ll need to complete after the PHE and flexibilities that came with it end to ensure eligible beneficiaries don’t lose coverage.

States expressed concern that the original six-month timeframe CMS gave in December 2020 to complete growing backlogs would result in a “renewal bulge,” causing greater administrative burden that could be much more manageable within a larger time frame, according to the letter.

Beneficiaries also risk losing coverage if states held to that timeframe are unable to conduct outreach and put in place strategies to make accurate redeterminations and renewals.

The previous guidance also allowed states to avoid completing another redetermination before terminating coverage after the PHE ends if certain conditions are met, including that eligibility actions processed during the PHE were finished within six months of the beneficiary’s termination after the PHE.

But allowing states to avoid “repeat redeterminations” carries the risk that coverage will be terminated for some eligible beneficiaries, and CMS is rescinding that option in the new guidance. 

Under the updated policy, states can’t terminate any person determined eligible for Medicaid during the PHE, including people who failed to respond to requests for information, until the state has completed a redetermination after the PHE ends.

Before taking an adverse action toward any beneficiary, states must complete an additional redetermination that includes checking available information and data sources without contacting the beneficiary and requesting documents to obtain reliable information when eligibility cannot be renewed based on available information, according to the letter.

With the extended timeframe, CMS said states should reassess their risk-based approach to prioritizing pending work and prepare to restore routine operations after the emergency ends. Their risk-based approach should promote continuity of coverage for those eligible and limit delays in processing for those newly eligible or eligible for more comprehensive coverage.

“CMS is available to provide technical assistance to states that are working to complete pending eligibility and enrollment work within the 12-month timeframe, and we remain interested in hearing state feedback and concerns as states plan for and resume routine operations consistent with the expectations outlined in this letter,” the agency said.

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Framework for $3.5T Senate package seeks to close Medicaid gap, add new Medicare benefits and tackle drug prices

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The bill includes funding for the “backup plan” which would expand Medicaid to all states whether they want to or not.



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.



Senate Democrats have laid out their policies to be included in a $3.5 trillion infrastructure package, including drug pricing negotiation authority for Medicare. (Getty/Tero Vesalainen)

Senate Democrats want to give Medicare the power to negotiate for lower drug prices, add new benefits to Medicare and close a Medicaid coverage gap in a new $3.5 trillion infrastructure package.

Democrats unveiled on Monday their budget resolution for the package, the first step to passing the legislation in the Senate.

The budget resolution, set to be considered in the chamber this week, outlines ambitious and long-held Democratic healthcare policies that the final legislation is likely to include.

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The policies included in the resolution include:

  • Adding dental, hearing and vision benefits to Medicare.
  • Giving Medicare the power to negotiate lower drug prices. Sen. Bernie Sanders, I-Vt., a leading negotiator on the package, tweeted Monday that the savings from drug price negotiations will help pay for other parts of the package such as adding the new benefits to Medicare.
  • Creating a new federal program to cover Americans who would be eligible for Medicaid if their state had expanded the program under the Affordable Care Act. Several senators have proposed legislation to create a separate, Medicaid-like program to cover these residents.
  • Making new investments in home and community-based services to “help seniors, persons with disabilities and home care workers,” the resolution said. A roughly $1 trillion bipartisan infrastructure package originally included investments for home care, but that money didn’t make it into the final package to be considered this week.
  • Extending a boost to ACA income-based subsidies that were included in the American Rescue Plan Act. The boosted subsidies are set to expire after the 2022 coverage year.

Democrats in the House and Senate aim to pass the $3.5 trillion package via reconciliation, a procedural move that allows budget bills to move through the Senate via a simple majority and avoid a legislative filibuster.

Each committee will craft and pass its own part of the package and then the Senate will bundle them together for final passage, which is likely to occur after the nearly monthlong August recess.

The Senate is expected to pass this week a roughly $1 trillion bipartisan infrastructure package that would delay until 2026 a controversial Part D rebate rule and restart Medicare sequester cuts that were on pause during the pandemic.

House Speaker Nancy Pelosi has said that she wants to pass the bipartisan infrastructure package and the $3.5 trillion legislation at the same time.

The hospital advocacy group Federation of American Hospitals praised most of the health proposals, including making the enhanced ACA subsidies permanent and closing the Medicaid gap. 

FAH President Chip Kahn said in a statement that the best way to close the Medicaid gap is to build on the ACA and not to create a separate program, as legislation endorsed by several Democrats aims to do.

Kahn also cautioned Democrats against raising the corporate tax rate to help pay for the package. 

“Raising the corporate tax rate is the wrong prescription at the wrong time,” he said. “It punishes the very domestic companies still recovering from the ongoing pandemic, and which we count on to grow the economy and create jobs.”


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