Posted on

KS- Gov. wants federal workaround for Medicaid expansion

MM Curator summary


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.


Clipped from:



Posted on

State funds for Oklahoma Medicaid expansion remain untouched

MM Curator summary


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.


Clipped from:



Posted on

State to expand Medicaid eligibility following court ruling

MM Curator summary


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.

Clipped from:

Posted on

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

MM Curator summary


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.

Clipped from:

Posted on

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

MM Curator summary


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.

Sponsored by IQVIA 

Transformative insights for the future of healthcare

IQVIA is healthcare’s vital partner. Drive smarter decision making, improve risk management, and optimize operating efficiency. Learn how IQVIA can help your organization.


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.”


Clipped from:

Posted on

MISSOURI- DSS needs additional employees and two months to implement Missouri Medicaid expansion

MM Curator summary


After being forced to expand Medicaid without funding for it, the Medicaid agency is letting the legislature know they are not staffed to implement 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.


Missouri’s Solicitor General says the state Department of Social Services (DSS) needs two months to implement voter-approved Medicaid expansion.


Cole County Circuit Judge Jon Edward Beetem views a slide presentation from attorney Chuck Hatfield during a June 21st hearing in Jefferson City on Missouri’s Medicaid expansion lawsuit (file photo courtesy of News-Tribune” pool photographer Julie Smith)

D. John Sauer made his comments Friday afternoon to Cole County Circuit Judge Jon Beetem, saying DSS needs more employees and computer upgrades for implementation. Attorney Chuck Hatfield, who represents the three low-income women suing Missouri, disagrees.

“They believe that they need another two months, and I’m not sure I said it this way in there (Cole County Circuit Court), we don’t think they’re (the state) entitled to another two months of not complying with the law. They need to comply with the law now,” Hatfield told Capitol reporters Friday, outside the Cole County Courthouse.

Counselor Hatfield wants the judge to issue a final order quickly.

“What we asked the court to do today is to say that the state may not deny applications of folks who are eligible for Medicaid, under the (Missouri) Supreme Court’s decision. And the Supreme Court pretty clearly said that the provisions of the (state) Constitution that expanded Medicaid are valid and now in effect,” Hatfield says.

The Missouri Supreme Court issued a unanimous decision on July 22, ruling that Missouri’s Medicaid expansion ballot measure was constitutional. The court sent the case back to Judge Beetem for him to enter a judgment for Hatfield’s three clients. Hatfield expects a ruling within a few business days.

Hatfield’s three clients are Stephanie Doyle of St. Louis, Melinda Hille of Fenton and Springfield’s Autumn Stultz. They suffer from diabetes and various skin conditions. Hatfield tells Capitol reporters that his clients “don’t care about computers. Do it (process applications) by paper if you need to. They want their health care.”

Hatfield also notes that Governor Mike Parson (R) called for implementation of Medicaid expansion during his January State of the State address, and says it was six weeks away from implementation in May. That’s when the GOP-controlled Legislature decided not to fund the expansion.

53 percent of Missouri voters approved Medicaid expansion in August 2020. However, it failed in 107 of Missouri’s 114 counties. The opposition to Medicaid expansion this year primarily came from rural GOP lawmakers who represent those districts. They say Missouri cannot afford Medicaid expansion.

While Hatfield wants the judge to issue a final order quickly, Solicitor General Sauer is requesting another hearing in Cole County Circuit Court to give a Missouri Medicaid representative an opportunity to testify on DSS’ needs. Sauer also says a representative from DSS’s Family Support Division should testify.

Medicaid is a federal and state program that assists with medical costs for residents with limited incomes. Medicaid expansion supporters say it would help the working poor across the state. They say it will provide healthcare to Missourians who earn less than $18,000 annually.

DSS statistics show that 1,089,379 Missourians are currently receiving Medicaid benefits. That number has increased for 11 straight months.


Clipped from:

Posted on

Judge rules Missouri doesn’t have to implement Medicaid expansion

MM Curator summary


The judge said the state constitution requires specific funding for voter-approved initiatives.


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.


A Missouri judge on Wednesday ruled against a lawsuit seeking to force the state to implement Medicaid expansion under the Affordable Care Act, a setback for supporters of expansion.


© Istock Judge rules Missouri doesn’t have to implement Medicaid expansion

The ruling will be appealed, though, meaning it is not the final word.


Missouri voters passed a ballot measure last year to expand Medicaid, but GOP Gov. Mike Parson said in May he would drop plans to expand the program after the Republican-controlled legislature declined to provide funding for it.

Supporters of Medicaid expansion sued, seeking to force the state to expand the program starting July 1, which would provide health insurance to about 275,000 low-income people.

Judge Jon Beetem ruled against the lawsuit on Wednesday, writing that the voter-approved ballot measure was actually unconstitutional, since it sought to spend state funds without identifying a funding source, infringing on the legislature’s appropriations power.

“It is unfortunate that, yet again, hundreds of thousands of Missourians will have to wait even longer to access the health care they need,” Dwayne Proctor, CEO of the Missouri Foundation for Health, said in a statement.

Supporters of expansion said they would appeal.

The setback for expansion in Missouri comes as congressional Democrats are exploring ways to go around states and expand the program in the 12 states that have still not accepted expansion.

A federal program to provide coverage in those states could be included in an upcoming legislative package.


Clipped from:

Posted on

Texas Democrats propose bill to let local governments expand Medicaid without state consent

MM Curator summary


A new plan from Dems would allow counties to operate Medicaid programs, get federal matching and force states to let them use state systems.


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.



AUSTIN — Local governments would be able to bypass conservative state leaders and implement their own Medicaid expansion programs for working poor Texans with federal funds, under federal legislation announced Monday by U.S. Rep. Lloyd Doggett, D-Austin.

Dubbed the “Cover Outstanding Vulnerable Expansion-Eligible Residents Now Act,” the legislation is a “homegrown solution” to a decade of resistance by a handful of red states to allowing more people who are struggling financially to access the federal health care program, said Doggett, chairman of the House Ways and Means Health Subcommittee and lead sponsor of the bill, which has more than 40 cosponsors.

In Texas, that could be as many as 1 million newly eligible residents — most of them people of color — who currently fall into that gap because they can’t afford private health insurance and can’t qualify for subsidies, but make too much to qualify for Medicaid.

The bill sponsors include all of the Texas congressional Democrats and most Democrats from 12 other states that have refused to expand Medicaid through the Affordable Care Act. It is the first time local governments have been able to directly contract with the federal government for Medicaid funds.

“For many of our most disadvantaged citizens, this bill offers a pathway to access a family physician, necessary medicine, and other essential coverage that thirteen States continue to deny,” Doggett said in a statement. “The COVER Now Act empowers local leaders to assure that the obstructionists at the top can no longer harm the most at-risk living at the bottom.”

The bill allows counties, cities and other political subdivisions to apply directly to the U.S. Centers for Medicare and Medicaid Services for funds that were declined by their states, including Texas. States would be required to cooperate and authorize access to state Medicaid systems for those entities, with incentives for cooperation and potential penalties otherwise.

That amounts to 100% federal funding for three years and tapering to 90% federal funding by year seven and beyond, Doggett said.

The bill will be filed later Monday, he said. Other proposals being floated in D.C. include doing the same thing through a federal program or expanding access to the marketplace to lower income people, Doggett said.

“All of these have pros and cons,” he said.

An effort by a bipartisan coalition of state lawmakers to expand Medicaid during the most recent session of the Texas Legislature became mired in conservative opposition and never got a hearing.

Opponents of expanding Medicaid to an estimated 1 million Texans who would qualify under the Affordable Care Act of 2010 argue that the program is poorly managed and financially unsustainable, and that expansion encourages government dependence, delivers poor health outcomes, and crowds out children and people with disabilities who need it the most.

The new federal legislation would further burden a program that is already “a poorly performing program which leaves millions of low-income and disabled Americans without real access to quality care,” said David Balat, director of the Right on Healthcare initiative at the Texas Public Policy Foundation, a conservative think tank.

Balat pointed to several measures that were passed by the Texas Legislature this year, and championed by conservative leaders, that are “strong steps” toward helping the uninsured, would serve more people than would be covered by Medicaid expansion, and don’t threaten funding for other services like education and public safety, he said.

Some of those measures included programs that reduce the cost of some prescription drugs, ease continuity of Medicaid coverage for children, require transparency in medical billing, expand availability of telehealth and broadband services, expand Medicaid coverage for new mothers, and increase insurance plan options through small businesses, agricultural nonprofits and associations, among others.

“Putting millions more people into a struggling program will only further hurt current beneficiaries, mostly low-income women and children, the elderly and the disabled, and do nothing to address the existing issues of access to care,” he said. “The bottom line is that this is just an effort by some counties and cities to gain access to federal dollars without actually doing anything to help patients.”

A request for comment from Republican Gov. Greg Abbott, who has resisted calls to expand Medicaid, was not immediately answered on Monday morning.

The death of the state legislation left on the table billions of dollars in federal incentives that supporters said would not only have paid for the expansion but added money to state coffers and lowered costs for hospitals that care for large numbers of uninsured patients.

“The lack of access to health care during COVID killed people. It killed people. It decimated their finances, it drove people deeper into poverty. And we’re not talking about poverty that only impacts immediately family at that given time. I’m talking about generational poverty, and on the border, it is most chronic,” said U.S. Rep. Veronica Escobar, D-El Paso. “We’ve got to stop hoping they [state leaders] will open their hearts and get off the culture war train, and we’ve got to take care of our people.”

Under Doggett’s proposed COVER Now Act, that money would be directly available to local governments through pilot programs approved by CMS without the state’s involvement.

“Health care coverage is as vital to a community as education, roads, or reliable power,” said Tom Banning, CEO of Texas Academy of Family Physicians, which supports the proposed legislation. “Sadly Texas has stubbornly refused federal assistance to expand Medicaid, leaving millions of our fellow Texans to get their health care by waiting in a long line at a free clinic, ignoring a treatable problem, or using the ER when that treatable problem worsens. That isn’t just morally wrong, its economically dumb.”

With more than 5 million of its residents without coverage, Texas has the largest number of uninsured residents in the nation, many of them working adults who can’t afford private or subsidized insurance but don’t qualify for Medicaid because they earn too much.

Roughly 20% of the state’s population lacks health insurance — a number health officials say has grown since more than a million Texans lost jobs and, in many cases, health coverage because of the COVID-19 pandemic.

Some 4.2 million people are on Medicaid in Texas — including more than 3 million children. The rest of the recipients are people with disabilities, pregnant women and parents living below 14% of the federal poverty level, or about $300 per month for a family of four.

Adults with no disabilities or dependent children don’t qualify for Medicaid, and the vast majority of children on Medicaid have parents who do not qualify.

The ACA allows states to expand that threshold to 138% of the poverty level, or $3,000 per month for a family of four.

In a University of Texas/Texas Tribune Poll conducted in April, 55% of Texas voters said they support Medicaid expansion, while 26% opposed it and another 20% said they didn’t know or had no opinion. Two recent polls by other groups show that 70% of Texans support Medicaid expansion.

Support local journalism.

We are making critical coverage of the coronavirus available for free. Please consider subscribing so we can continue to bring you the latest news and information on this developing story.

Clipped from:



Posted on

Democrats are working on a ‘Plan A’ for finally getting full Medicaid expansion

MM Curator summary

A new plan from Dems would bypass the state nature of Medicaid entirely.

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.

with Alexandra Ellerbeck

Republicans’ long effort to ditch Obamacare seems finally in the rearview mirror, now that the Supreme Court has thrice upheld it.

The road ahead will look very different for the law, as it enters what many view as a new phase of life.

“The ‘Repeal and Replace’ Era Is Over; The ‘ACA Expansion’ Era Begins,” Chris Condeluci, a health policy consultant, wrote in an email to clients this week.

First up: Medicaid expansion.

Democrats have been devising several different strategies for getting health insurance to people in the “coverage gap” — a population that would have otherwise been eligible for expanded Medicaid except for the fact that their states refused to expand the program. This includes roughly 4.3 million Americans in a dozen states.

Their first approach — incentivizing states to expand by giving them extra federal money to do so — hasn’t seemed to work, at least so far. A second approach rolled out by Rep. Lloyd Doggett (D-Tex.) is creative but could be logistically difficult to implement and perhaps even impossible under persistent state resistance (we wrote about Doggett’s bill here).

© Sergio Flores/Getty Images Rep. Lloyd Doggett speaks at a rally in Austin. (Sergio Flores/Getty Images)

So Democrats are working on a third approach.

The legislation — which two health policy experts described to me as Democrats’ “Plan A” for Medicaid expansion — is being crafted by staff members on the House Energy and Commerce Committee. 

The main thrust of the pending legislation is to circumvent the GOP-led states still refusing to expand Medicaid, and find a way to get the free or low-cost coverage to people in the coverage gap, who typically earn at or below the federal poverty level. The bill could take two basic routes to get there — and it’s unclear which one staffers have settled on.

  • One approach would be to allow the coverage gap population to buy fully subsidized plans on or the state-run marketplaces. As Judy Solomon writes at the Center on Budget and Policy Priorities, this would require policymakers to make changes in benefits, cost-sharing and enrollment processes.
  • Another approach would be to set up a federalized Medicaid program. It probably would involve direct contracts between the Centers for Medicare and Medicaid Services and managed-care companies to administer Medicaid benefits to people in the coverage gap.

The first method — using the marketplace — could raise some cost concerns, considering it’s far more expensive to insure people through private plans than through Medicaid, which pays providers lower rates. There’s also a worry that both approaches could incentivize states that already expanded Medicaid to drop the coverage, if the federal government starts fully funding the expansion population through a new route.

Democrats are keeping their plans close to the vest.

An Energy and Commerce Committee spokesman declined to offer any details about the legislation, offering only a generic statement about the committee’s work.

“The committee is continuing to work on a comprehensive solution to provide coverage to Americans who are trapped in the Medicaid coverage gap through no fault of their own,” the statement said. “Our priority is crafting a policy fix that provides coverage and access to care to everyone in the states that have not expanded and not limited to certain counties.”

Whatever the bill ends up looking like, Democrats are hoping to include it in any budget reconciliation package Congress tries to pass this year. But those plans are still up in the air, as a bipartisan group of senators tries to negotiate an infrastructure deal with the White House, which would allow Democrats to wait on passing a partisan reconciliation bill until later in the year.

The Post’s Jeff Stein, who has been covering the negotiations:

Ahh, oof and ouch

AHH: The White House said the United States will miss Biden’s July 4 vaccination goal.

Clipped from:

Posted on

Missouri lawmakers expect special session next week to renew important Medicaid tax

MM Curator summary


Republicans are fighting to prevent Medicaid paying for abortion drugs via withholding support for continuing a financing scheme that sends more money to large hospitals.


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.


JEFFERSON CITY, Mo. – Missouri lawmakers could be headed back to the capital city as soon as Monday to renew an important tax that funds the state’s Medicaid program after members could not reach a compromise before they adjourned from the legislature’s regular session.

Governor Mike Parson said he’s still planning to make budget cuts if there’s not a solution by July 1 to pass a new Federal Reimbursement Allowance (FRA) program.

“We’re going to have to move forward because I can’t delay it any longer,” Parson told reporters Tuesday. “July 1 there will be withholds, there is no other option for us.”

The FRA is a tax collected from medical providers like hospitals to support Medicaid. House Budget Committee Chairman Rep. Cody Smith (R-Carthage) said the tax brings in $1.6 billion a year.

“For about every FRA dollar we get, we get about two federal dollars for that and then we take all that money and we put it towards our Medicaid program,” Smith said.

The holdup for the General Assembly is if abortion providers and affiliates and certain contraceptives like Plan B should be covered for women who are already on Medicaid. What’s on the line is billions of dollars for the state’s program.

“The Republican party in the state of Missouri has shown no abandonment for women’s reproductive rights,” Senate Minority Floor Leader John Rizzo (D-Independence) said. “They’re trying to conflate abortion and birth control and the two things are not the same.”

Since lawmakers didn’t get it done before they adjourned, they have to come back for a special session since the FRA expires Sept. 30.

“I’m optimistic that we will be able to come to some compromise on a plan that enables us to go in legislate this fairly quickly and get it to the governor’s desk by the end of the month,” Smith said.

Lawmakers said the problem in finding a compromise is whether or not to allow Medicaid to cover contraceptives. During the last week of session, Sen. Paul Wieland (R-Imperial) attached an amendment to Senate Bill 1 that bans the use of FRA funds for contraceptives and abortions.

“You are literally putting $4 billion dollars in flux that is used to provide healthcare for Missourians over contraception, over birth control,” Rizzo said.

Republican Senators met with Parson Tuesday afternoon to try and find a compromise to renew the FRA. Part of the new language in the drafted legislation says:

Family planning as defined by federal rules and regulations; provided that such family planning services shall not include abortions or any abortifacient drug or device unless such abortions are certified in writing by a physician to the MO HealthNet agency that, in the physician’s professional judgment, the life of the mother would be endangered if the fetus were carried to term.

It goes on to say that an “abortifacient drug or device” include Plan B and intrauterine devices (IUD).

“We have a pro-life super majority on the Republican side and many of our members care about those issues,” Smith said.

Missouri has used the FRA for more than 20 years to fund the state’s Medicaid program. Parson said if it’s not renewed, it will more than a billion-dollar hole in the budget.

“If we can stay in the guidelines, if we can have language in there that doesn’t jeopardize the FRA and doesn’t jeopardize our CMS [Centers for Medicare and Medicaid Services], then we would be willing to take a look at something like that,” Parson said.

Rizzo said he hopes the governor “narrows” the call for the special session so lawmakers can pass a “clean FRA.”

“I think that there is still a lot of fence mending that needs to happen that hasn’t happened yet, I also think that we are adults, and we understand that this is something that could be catastrophe to the state of Missouri if we don’t get it done,” Rizzo said.

He believes lawmakers will be back at the Capitol starting Monday to start working on a plan to renew the FRA. Rizzo said the legislation will start in the Senate and then move over to the House.

Parson’s office has not confirmed when legislators will be back in Jefferson City.

Clipped from: