MM Curator summary

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.

 
 

[MM Curator Summary]: Seems that enrollment goes a little slower when you have to commit to working, learning or volunteering in order to get the Medicaid card. Opposing view: DCH is not doing a lot of marketing efforts for the new coverage.

 
 

 
 

Clipped from: https://abcnews.go.com/Health/wireStory/georgia-medicaid-program-work-requirement-off-slow-start-102389380

Public health advocates say Georgia appears to be doing little to promote its new Medicaid plan or enroll people in it

 
 

This photo provided by Amanda Lucas shows Amanda Lucas, right, with her father, Thomas Lucas, on Wednesday, Aug. 16, 2023, outside his home in Warner Robins, Ga. Amanda Lucas said she cannot meet the work requirement in Georgia’s new Medicaid pla…

The Associated Press

ATLANTA — Georgia Gov. Brian Kemp signed paperwork creating a new state health plan for low-income residents to much fanfare at the state Capitol three years ago.

But public health experts and advocates say since it launched on July 1, state officials appear to be doing little to promote or enroll people in the nation’s only Medicaid program that makes recipients meet a work requirement.

The Georgia Department of Community Health, which has projected up to 100,000 people could eventually benefit from Georgia Pathways to Coverage, had approved just 265 applications by early August.

“If we’re talking about directed outreach to the population that would most likely be eligible and interested, I haven’t seen anything,” said Harry Heiman, a health policy professor at Georgia State University.

Heiman and other experts say the program’s slow start reflects fundamental flaws missing from Medicaid expansions in other states, including the extra burden of submitting and verifying work hours. And some critics note it’s happening just as the state, as part of a federally mandated review, is kicking tens of thousands of people off its Medicaid rolls — at least some of whom could be eligible for Pathways.

“We’ve chosen a much more complicated and lengthy process that will take a long time even for the few folks who get coverage,” said Laura Colbert, executive director of the advocacy group Georgians for a Healthy Future.

The Biden administration has already tried to revoke Georgia’s Medicaid plan once and will be monitoring it, so any missteps could have broader consequences. They could also hamper future efforts by Republicans to make Medicaid eligibility dependent on work.

A spokesman for the governor’s office, Garrison Douglas, said enrollment would grow as applications continue to be reviewed.

“While the federal government initiated and dictated a process for re-determining the qualifications of traditional Medicaid recipients, Georgia is the only state in the country simultaneously offering a new pathway to healthcare coverage and opportunity,” he said in a statement.

The state’s department of community health said it was engaging stakeholders, community partners and others to help get the word out about the program. It did not provide details about that effort.

“There’s still some more work that we have to do for Pathways,” Lynnette Rhodes, executive director of DCH’s Medical Assistance Plans division, said at a meeting this month. “But overall…the program is working.”

The state launched Pathways just as it began a review of Medicaid eligibility following the end of the COVID-19 public health emergency. Federal law prohibited states from removing people from Medicaid during the three-year emergency.

Georgia has already cut more than 170,000 adults and kids from Medicaid and is expected to remove thousands more as the yearlong review of all 2.7 million Medicaid recipients in the state continues. Nationwide, more than a million people have been dropped from Medicaid, most for failing to fill out paperwork.

The department of community health said it delayed the reevaluations of 160,000 people who were no longer eligible for traditional Medicaid but could qualify for Pathways to help them try to maintain health coverage. It was not immediately clear whether the state reached out to those people and helped guide them to apply for Pathways.

“From what we have seen thus far, they are not doing anything affirmatively to get these people enrolled in Pathways,” said Cynthia Gibson, an attorney with the Georgia Legal Services Program who helps people obtain Medicaid coverage.

In contrast, Oklahoma officials implementing a voter-approved expansion of Medicaid in 2021 moved people in existing state insurance programs directly into the expansion pool without the need for a new application, according to the Oklahoma Health Care Authority. Nearly 100,000 people were enrolled in the expanded program within days of its launch.

“States have a lot of tools that they can use to help make this process go more smoothly,” said Lucy Dagneau, an advocate for Medicaid expansion with the American Cancer Society Cancer Action Network.

Oklahoma and 39 other states have expanded Medicaid eligibility to nearly all adults with incomes up to 138% of the federal poverty level, $20,120 annually for a single person and $41,400 for a family of four. None of those states require recipients to work in order to qualify.

That broader Medicaid expansion was a key part of President Barack Obama‘s health care overhaul in 2010, but many Republican governors, including Kemp, rejected it. In addition to imposing a work requirement, Pathways limits coverage to able-bodied adults earning up to 100% of the poverty line — $14,580 for a single person or $30,000 for a family of four.

Kemp has argued full expansion would cost too much money. State officials and supporters of Pathways say the work requirement will also help transition Medicaid recipients to better, private health insurance, and working, studying or volunteering leads to improved health.

“I’m excited we’re moving forward in this direction,” said Jason Bearden, president of CareSource Georgia, one of the state’s Medicaid health plans. “This is good progress.”

Critics say many low-income people work informal jobs and have fluctuating hours that will make it hard for them to document the required 80 hours a month of work, volunteer activity, study or vocational rehabilitation. They also blast the lack of an exemption to the work requirement for parents and other caregivers.

For Amanda Lucas, the work requirement is insurmountable right now.

Lucas said she had no idea Pathways started in July, but even if she did, she would not qualify because she has to take care of her 84-year-old father in Warner Robins, a city about 100 miles (160 km) south of Atlanta. He had a stroke and needs her to buy groceries, make food, pick up prescriptions, pay bills and manage myriad other tasks, she said.

With risk factors for skin cancer, she worries about living without health insurance.

“I try to keep an eye on my own moles,” she said. “I’m increasingly anxious because I’m 46.”

MM Curator summary

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.

 
 

[MM Curator Summary]: Lots of examples of expansion not being the panacea promised.

 
 

 
 

Clipped from: https://ocpathink.org/post/independent-journalism/medicaid-expansion-failing-rural-hospitals

 
 

When State Question 802 narrowly passed a voter referendum in June 2020, allowing able-bodied adults to be added to the state’s Medicaid program, backers promised it would financially stabilize and save rural hospitals.

But a new report shows that more than two years into Medicaid expansion in Oklahoma the share of rural hospitals facing financial challenges has increased.

A report by the Center for Healthcare Quality and Payment Reform (CHQPR) found that about half of Oklahoma’s rural hospitals are at risk of closing with nearly one-in-three rural hospitals at risk of “immediate” closure.

According to the report, Oklahoma has 37 rural hospitals that are at risk of closing with 24 facing “immediate” risk of closing.

The Center for Healthcare Quality and Payment Reform also reported that 58 of Oklahoma’s 78 rural hospitals, or 74%, are reporting financial losses on services.

Those figures run counter to the promises made by advocates of Medicaid expansion.

Under the 2010 federal Affordable Care Act, better known as “Obamacare,” states were allowed to expand Medicaid to add many able-bodied adults to the welfare program. However, Oklahoma policymakers did not embrace the expansion for several years because of the increased state cost.

Eventually, activists used the initiative petition process to put expansion on the ballot as State Question 802. The measure passed by a very slim margin in June 2020, and Medicaid expansion went into effect starting in July 2021.

The SQ 802 campaign included many promises that Medicaid expansion would provide financial security for rural hospitals.

The website for the “Yes on 802” campaign declared that Medicaid expansion would increase spending by $1 billion per year in Oklahoma “and keep our rural hospitals open.” A campaign ad for “Yes on 802” similarly claimed Medicaid expansion would “keep rural hospitals open.”

But the Center for Healthcare Quality and Payment Reform report indicates that rural hospitals are worse off today than they were prior to Medicaid expansion.

In July 2019, prior to Medicaid expansion, GateHouse Media reported that 52% of rural hospitals in Oklahoma lost money from 2011 through 2017. That’s a lower share than the 74% reporting financial losses today, according to the Center for Healthcare Quality and Payment Reform report.

That outcome doesn’t surprise one expert who has followed Medicaid expansion across the nation.
 

“Medicaid expansion doesn’t save hospitals—it harms them,” said Hayden Dublois, data & analytics director for the Foundation for Government Accountability. “Nearly 50 hospitals have closed in expansion states since 2014–representing almost 5,400 hospital beds—despite the promises by advocates that expansion would be a silver bullet for hospital finances. Some of these hospitals directly cited expansion as a reason for closure. In contrast, hospital closures in non-expansion states are almost never caused by a lack of Medicaid expansion.”

While Medicaid expansion has not reduced the number of at-risk rural hospitals, it has increased taxpayer spending on the program.

The Oklahoma Health Care Authority, which administers Medicaid, reported that Medicaid spending in Oklahoma surged from just over $6 billion in 2021 to more than $7.8 billion in the 2022 state budget year. That was a spending increase of nearly 48% compared to 2017 with much of the new spending in 2022 tied to Medicaid expansion.

So if taxpayer spending went up and the number of patients on Medicaid increased, why have rural hospitals not become more financially sound?

“The reasoning is simple: since Medicaid reimburses hospitals at lower levels than private insurance, hospitals are financially harmed as countless able-bodied adults move off of exchange plans and employers’ plans and onto Medicaid,” Dublois said.

That’s a reality Medicaid-expansion backers previously admitted.

At a September 2019 legislative meeting, Jay Johnson, president and CEO of Duncan Regional Hospital and chairman of the Oklahoma Hospital Association’s executive committee, admitted that hospitals lose money on Medicaid patients.

“On every government payer, we don’t make a profit,” Johnson said. “At our hospital, whether we’re taking a Medicare or Medicaid patient, our expenses are greater than what we will get paid.”

(Johnson endorsed Medicaid expansion anyway even after saying the program creates financial problems for hospitals.)

Critics, such as Dublois, have long noted that individuals added to Medicaid through the Affordable Care Act’s expansion include many people who would have otherwise had private insurance. Because Medicaid reimburses roughly 60 percent of what private insurance reimburse nationwide, that translates into greater financial losses for many hospitals after Medicaid expansion.

The Center for Healthcare Quality and Payment Reform report noted that the factors causing financial losses at rural hospitals include the fact that “at-risk hospitals are losing money on uninsured patients and Medicaid patients.”

At rural hospitals that are not at risk of closure, the report stated those facilities “receive payments from private health plans that not only cover the costs of delivering services to the patients with private insurance, but those payments also offset the hospitals’ losses on services delivered to uninsured and Medicaid patients.”

In effect, that means people with private insurance are paying higher rates to cover the hospital losses created by Medicaid patients.

“Most ‘solutions’ for rural hospitals have focused on increasing Medicare or Medicaid payments or expanding Medicaid eligibility due to a mistaken belief that most rural patients are insured by Medicare and Medicaid or are uninsured,” the Center for Healthcare Quality and Payment Reform report stated. “In reality, about half of the services at the average rural hospital are delivered to patients with private insurance (both employer-sponsored insurance and Medicare Advantage plans).”
 

In neighboring Texas, which has not expanded Medicaid, the report showed that a significantly lower share of rural hospitals report losses than their counterparts in Oklahoma. But in New York, which has expanded Medicaid, 80% of rural hospitals reported losses and 43% were at risk of immediate closure, surpassing even Oklahoma’s dismal numbers.

Dublois noted that the CHQPR study shows that roughly one in four rural hospitals “are at risk of closure in states that have already expanded Medicaid.”

The CHQPR report is not the only study that has highlighted that trend.

A 2019 report by Navigant Consulting included data on states with the most community-essential rural hospitals at risk for closure. The five states with the highest number of those facilities were states that had expanded Medicaid.

Reliance on Medicaid was a factor in the financial woes of rural hospitals, according to the report.

“Residents who remain in rural communities tend to be either very old or very young, and these communities often have higher rates of uninsured, Medicaid, and Medicare patients, leading to more uncompensated and under-compensated care,” the Navigant report stated.

SQ 802 narrowly passed with just 50.49% of the vote with the “yes” vote prevailing primarily because of mail-in absentee votes from urban areas. Statewide, a majority of voters in 70 of Oklahoma’s 77 counties voted “no” on SQ 802.

Some who advocated for Medicaid expansion at that time express no second thoughts despite the worsening trend lines in rural hospitals after expansion was implemented.

“Medicaid expansion has been tremendously successful in every state where it has been implemented and not a single rural hospital has closed in Oklahoma for financial reasons since its implementation two years ago,” said Rich Rasmussen, president & CEO, Oklahoma Hospital Association.

But others express concern about hospital stability although they have not expressly linked those financial challenges to Medicaid expansion.

State Rep. Marcus McEntire, a Duncan Republican who was a vocal advocate for Medicaid expansion, continued to tout the program as recently as last year.

On his campaign website, which is updated through 2022, McEntire declared, “We are at the cusp of rural hospitals being financially self-sufficient since the ACA (Affordable Care Act) was passed.”

But by April 2023, McEntire’s tune had changed regarding hospital stability. In an article in The Oklahoman, which focused on a dispute over $600 million in federal COVID bailout funds, McEntire declared, “My concern is that we don’t use the $600 million for stabilizing the health care system because right now the hospitals are all under water.”

For opponents of Medicaid expansion, the current landscape of rural health care in Oklahoma is not shocking.

“Put simply, expansion isn’t a silver bullet for hospitals,” Dublois said. “It’s a nail in the coffin.”
 

MM Curator summary

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.

 
 

[MM Curator Summary]: GA Medicaid expansion has started.

 
 

Clipped from: https://www.walb.com/2023/07/21/georgia-medicaid-program-aims-expand-access-benefits-those-need/

ALBANY, Ga. (WALB) – Medicaid is expanding to more Georgians.

WALB spoke to Georgia State Representative Penny Houston (R-Nashville) about a very important program starting up this month for the state of Georgia and people and people who may be challenged economically is called the Georgia Pathways to Coverage Expanding Medicaid.

“Well, there are many Georgians and citizens in Georgia who do not have access to coverage and don’t qualify for Medicaid,” Houston said. “And this is a program that the governor got a waiver for to include more people who do not qualify for Medicaid. And you have to be, within 10% —100% Of the poverty level. And are there other qualifications and it has most of the benefits that you get with Medicaid. There are future exclusions. One is transportation for a certain age group, but not to and from your doctor’s office. Of course, it does include transportation and ambulance services, but most of the things are already included: your doctor’s visits, your prescriptions, your emergency coverage for emergency rooms and those sort of things are already included. Your hospital stay. Your labs, your X-rays, all that are included in family planning.”

Another big part of this is preventative care: Wellness Care is also included in this, and that’s very much needed for people. And like you say, people who are working can qualify for this. It might lower their payments and their insurance. So it’s a very good thing and the application started in July.

“And July 1, and one other thing I’ve left out. That’s most important right now. And I would say, this does cover mental health services and mental health issues are something that have not been covered in a while. People are recognizing that so much mental health is really a disease,” Houston said.

To apply to the program online, click here. Georgians can also apply through the mail or in person at their local Division of Family and Children Services office. First applications can also be made by phone at 1-877-423-4746, or 711 for those that are deaf, hard of hearing or need extra assistance.

MM Curator summary

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.

 
 

[MM Curator Summary]: In which the Good Guvnr needs to appear tough.

 
 

 
 

Clipped from: https://www.politico.com/news/2023/07/26/roy-cooper-north-carolina-medicaid-expansion-00108297

Medicaid expansion is set to begin October 1 if Republican lawmakers fund it.

 
 

The state’s plan gives lawmakers until Sept. 1 to fund the proposal. State health officials said that by starting their work now, they can reduce the lead time needed to implement the program from 90 or 120 days after the legislature gives its final approval to 30 days.

If, however, lawmakers miss the September deadline, Medicaid expansion would be delayed until Dec. 1, health officials said.

North Carolina became the 40th state to approve Medicaid expansion in March, with more than 600,000 people expected to be eligible for the program when it takes effect.

Implementing Medicaid expansion has been a top priority for the two-term governor, who will leave office in 2025.

Republican lawmakers overcame years of opposition to approve the proposal but declined to fund it separately, wanting some leverage over Cooper as they hashed out the budget. In August, Cooper railed against lawmakers for tying expansion to the budget.

“Making Medicaid Expansion contingent on passing the budget was and is unnecessary, and now the failure of Republican legislators to pass the budget is ripping health care away from thousands of real people and costing our state and our hospitals millions of dollars,” Cooper said in a statement.

Lawmakers have shown no signs of budging — even though negotiations between House and Senate Republicans are on other issues, such as tax cuts and pay raises for state employees.

MM Curator summary

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.

 
 

[MM Curator Summary]: After a year or so of drama, shiny new Medicaid cards will be issued starting tomorrow.

 
 

 
 

Clipped from: https://www.capjournal.com/news/medicaid-expansion-in-south-dakota-begins-july-1/article_29483796-1435-11ee-a809-6f4a7861ec6b.html

 
 

Medicaid expansion begins in South Dakota on July 1, a move sparked by a successful ballot initiative last November in which 56% of South Dakotans voted for the expansion.

That means, according to the South Dakota Department of Social Services website, that “an estimated 52,000 new individuals” will qualify for Medicaid.

The expansion of Medicaid, which has rolled out on a state-by-state basis since the Affordable Care Act, was originally part of the ACA, with the federal government financing the expansion at 100% initially, and at 90% by 2020. But in 2012, when the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act, the Court also limited the federal government’s ability to enforce a Medicaid expansion provision, according to the Kaiser Family Foundation and other sources.

That left the decision to expand Medicaid up to the states.

“I expect more preventive care will be able to be received,” said Michaela Seiber, CEO of South Dakota Urban Indian Health. Seiber said that expansion could be especially helpful for people who need to follow up initial appointments with additional care.

 
 

Michaela Seiber

Courtesy photo

The DSS website notes that South Dakota applicants must be between 19 and 64 years old, must live in South Dakota, must be “a U.S. citizen or qualified immigrant,” and must either possess or have applied for a Social Security Number.

With the expansion, adults with incomes of up to 138% of the Federal Poverty Level will be eligible for Medicaid. That means single adults making up to about $20,120 per year will be eligible, and a family of four earning up to $41,400 will be eligible.

Applications for the expanded program began on June 1, and people who are already receiving Medicaid do not need to reapply.

Shelly Ten Napel, CEO of Community Healthcare Association of the Dakotas, said the expansion of Medicaid falls closely in line with its mission of serving underserved populations.

 
 

Shelly Ten Napel

Courtesy photo

“Our mission for over 40 years has been access to high-quality healthcare for all Dakotans,” she said. “This moment is a big one for us because adding another piece to the coverage puzzle is going to have an impact on the healthcare system in our state, on people’s lives, and it’s going to save lives.

The Community HealthCare Association of the Dakotas, as its website states, “is a non-profit membership organization that serves as the primary care association for North Dakota and South Dakota.”

Penny Kelley, outreach and enrollment services program manager for CHAD, also noted that the expansion could help patients obtain preventive care.

 
 

Penny Kelley

Courtesy photo

“For someone not able to get preventive care, oftentimes that can lead to a small problem being a big problem,” she said.

Kelley said the presence of health insurance creates “a ripple effect through the entire community,” preventing serious illnesses by allowing medical professionals to treat patients early.

“They’re not having to go to the ER because they were able to take care of (the problem) with their doctor ahead of time,” she said.

Seiber, with South Dakota Urban Indian Health, noted that federally qualified health centers offer sliding scales for people who don’t have insurance. The problems can surface, though, when those initial visits reveal conditions that require specialists.

“If they have something that’s more complex than we can provide for, they get referred out,” Seiber said. That sort of specialized care, along with the medications, may not be accessible on a sliding scale, she said.

Kelley stressed the importance of spreading the word about Medicaid expansion.

“There’s continued work to be done in order to let people know that they may be eligible,” she said. “They have received letters from the DSS letting them know, but that doesn’t always get someone’s attention. So we have been trying to do a lot of outreach.”

Kelley said, too, that efforts to reach people to tell them about Medicaid expansion can also create avenues to inform them about other areas of health.

“If they’re not eligible for Medicaid expansion, they could potentially be eligible for low-cost healthcare on Healthcare.gov,” she said.

Seiber noted that there’s a navigator working at South Dakota Urban Indian Health in Pierre who can help people with applications and other administrative tasks – such as applying for Medicaid. The position is funded by a federal grant received by the Community HealthCare Association of the Dakotas and applied to SDUIH’s navigator position.

The South Dakota Department of Social Services’ website notes that “90% of the cost of providing healthcare to the Medicaid expansion population will be funded by the federal government ($512,587,699)” – a provision of the Affordable Care Act – “and the state is required to pay for the remaining 10% ($66,385,019).” The American Rescue Plan provides additional funding.

South Dakota is among 40 states, along with Washington, D.C., that have expanded Medicaid. According to the Center on Budget and Policy Priorities, “Expansion has produced net savings for many states. That’s because the federal government pays the vast majority of the cost of expansion coverage, while expansion generates offsetting savings and, in many states, raises more revenue from the taxes that some states impose on health plans and providers.”

More information from the South Dakota Department of Social Services is available at https://dss.sd.gov/economicassistance/medical_eligibility.aspx, and people can contact the office in Pierre, at 912 E. Sioux Ave., with a phone number of 605-773-3612.

Kelley said people with questions about Medicaid expansion can also call the 211 helpline.

MM Curator summary

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.

 
 

[MM Curator Summary]: NH may not be re-upping its Medicaid expansion. Egads!

 
 

Clipped from: https://indepthnh.org/2023/05/23/house-finance-subcommittee-wants-to-hold-medicaid-expansion-bill-for-a-year/

 
 

The head of the state’s Medicaid program, Henry Lipman, talks to House Finance Committee’s Division III Tuesday about Senate Bill 263, which would reauthorize the Granite Advantage Health Care Program permanently.

By GARRY RAYNO, InDepthNH.org

CONCORD — A House Finance Committee’s subdivision wants to hold a bill reauthorizing the state’s Medicaid expansion program for a year.

Meeting Tuesday, the committee Division III voted down party lines to retain Senate Bill 263 although the Senate passed the bill unanimously and the House passed it 193-166 last week with no limitation on the program’s length.

The Granite Advantage Health Care program provides health insurance to the state’s “working poor” who earn too much to qualify for regular Medicaid, but not enough to purchase private insurance.

The program, which was part of the Affordable Care Act, provides Medicaid coverage to those from 133 to 100 percent of the federal poverty level with the federal government paying 90 percent of the cost.

The subcommittee voted down party lines, 5-4, to retain the bill, and the recommendation will go before the full House Finance Committee June 1 for its recommendation to the House for its June 8 session.

During last week’s session, Democrats and a handful of Republicans defeated about 20 of the 30 Republican proposed amendments to the bill, before passing it.

Many of the amendments defeated last week were brought up at the subcommittee meeting, including a work requirement, which the US Supreme Court had found unlawful in the past, as well as co-pays for services, drug testing, capping the length of time a person can be on the program and a clawback provision.

The list of concerns was developed by Rep. J.R. Hoell, R-Dunbarton, and read by Rep. Jim Kofalt, R-Wilton.

Rep. MaryJane Wallner, D-Concord, questioned why the subcommittee was bringing up the issues again.

“As I listen to the list it sounds sort of familiar to me. Many came forth last week as amendments and the House voted to reject them,” she said. “To bring them up at this point is not necessary and most of the things on the list are not related to finances.”

The bill received initial approval pending financial review by the House Finance Committee before a final vote on the bill.

But Rep. Erica Layon, R-Derry, who was a substitute member of the subcommittee, told Wallner debate was limited last Thursday when the bill was debated and many of the issues brought up were not debated on the floor.

“They were not thoroughly considered by limiting House debate,” she said.

Subdivision chair Rep. Jess Edwards, R-Auburn, said he talked with the bill’s prime sponsor, Senate President Jeb Bradley, R-Wolfeboro, who could not attend Tuesday’s meeting and said he told Bradley he was disappointed the House did not approve a six-year extension for the program.

Edwards said Bradley said a five-year contract with the Medicaid providers is best financially for the state, but contracts are often extended for a year or two.

Edwards said he could agree to a seven-year extension to accommodate that situation.

Henry Lipman, head of the Medicaid program for the Division of Health and Human Services, said the last contract had to be extended while the Executive Council sought additional information and input.

“Having that flexibility,” Lipman said, “makes sense.”
But Layon asked if it were more expensive to have the extension clause in the contract, but eventually Edwards said they probably would not know that until the final bids are known.

The chair of House Finance, Rep. Ken Weyler, R-Kingston, asked Lipman if there were no sunset provision in the bill, would it encourage the federal government to change how much it would pay for the cost..

Lipman said if the federal government drops its contribution to less than 90 percent, the current law requires the program to end regardless of what the legislators wanted to put in the current bill.

Kofalt said he believes a program as expensive and complex as the Medicaid program needs a sunset that would allow legislators to review it

He said there is often “creep” in programs as bills are introduced to add more benefits.

“This is a very, very expensive program to begin with,” Kofalt said. “(There needs to be) some kind of period to review the scope and complexity of the program. It really merits that.”
After a short caucus, Republicans moved to recommend the bill be retained with Layon saying work requirements are being debated  in Washington now in negotiations over raising the debt ceiling, and there may be other changes, so they would be wise to hold the bill for a year.

The bill has broad support among the business community, health care organizations and health care access advocates.

The subcommittee also voted down party lines to retain Senate Bill 239, which also passed the House last week.

The bill would have the state use harm reduction services to treat alcohol and other substance misuse and includes reauthorizing the needle exchange program.

But the subcommittee did recommend Senate Bill 172 pass, which allows court-appointed guardians to receive Temporary Assistance for Needy Families benefits for a child they are taking care of, such as grandparents or a mother’s sister.

The House has to act on these bills by June 8.

Garry Rayno may be reached at garry.rayno@yahoo.com.

MM Curator summary

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.

 
 

[MM Curator Summary]: MS lawmakers immune to advocate arguments.

 
 

Clipped from: https://mississippitoday.org/2023/02/01/medicaid-expansion-bills-die/

 
 

Speaker of the House Philip Gunn (AP Photo/Rogelio V. Solis)

More than 15 bills that would have expanded Medicaid to provide health care coverage to primarily the working poor died on Tuesday night without debate or a vote.

No committee chair in either the Senate or House held a hearing on those Medicaid expansion bills. The House Medicaid Committee, where Speaker of the House Philip Gunn assigned all of the his chamber’s expansion bills, did not even meet a single time before the Jan. 31 deadline to consider general bills.

READ MORE: ‘What’s your plan, watch Rome burn?’: Politicians continue to reject solution to growing hospital crisis

Legislative leaders killed the bills as a worsening hospital crisis grips the state and Mississippi continues to be among the unhealthiest states with the highest percentages of uninsured residents.

State Health Officer Dr. Daniel Edney told lawmakers in late 2022 that 38 hospitals across the state are in danger of closing, and all are facing financial hardships. Physicians and hospital leaders have said expanding Medicaid, which would result in more than $1 billion annually in additional federal health care dollars coming to the state, would help hospitals pay their bills. Beyond just helping hospitals, expanding Medicaid would provide health care coverage to many more Mississippians — up to 300,000, according to some studies.

 
 

But many in the Republican leadership of the state, primarily Gunn and Gov. Tate Reeves, have been adamant in their opposition to expanding Medicaid as 39 other states have done, including many led by Republican politicians.

Meanwhile, data shows that support for Medicaid expansion is growing among voters. A Mississippi Today/Siena College poll conducted in early January indicated that the vast majority of the general public, including 70% of Republican voters, favor expansion.

READ MORE: Poll: 80% of Mississippians favor Medicaid expansion

Rep. Robert Johnson, the House Democratic leader from Natchez, said the death of the bills this week was disappointing but not surprising.

Referring to Gov. Reeves’ State of the State speech earlier this week, Johnson pointed out that he spoke of health care alternatives rather than focusing on solutions for hospitals. Those could include stand-alone surgery centers, telemedicine and other alternatives.

“It seems he is talking about providing health care for selected people,” Johnson said, referring to those who would have health care alternatives that often require some type of insurance — either private or public like Medicaid.

While the Medicaid bills died, still alive is a more modest proposal to provide coverage for new mothers on Medicaid for a year instead of the current 60 days. The Senate is expected to pass the bill in the coming days and send it to the House for consideration.

Last year the Senate passed the bill to lengthen postpartum care from 60 days to one year, but it died in the House in large part because of opposition from Gunn and his health care leadership team, Public Health Chair Rep. Sam Mims of McComb and Medicaid Committee Chair Rep. Joey Hood of Ackerman.

While the Medicaid expansion bills all died, Johnson said there might be legislation that is alive where amendments could be offered to expand Medicaid.

“We will be vigilant in looking for every opportunity we can find to offer amendments to expand Medicaid and to provide needed money to hospitals in the short term,” Johnson said. “We have been here a month now and have not addressed that issue.”

READ MORE: Key bills — including Medicaid expansion — to watch in the 2023 Mississippi legislative session

 
 

MM Curator summary

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.

 
 

[MM Curator Summary]: A good example of the use of Rule #8 from Alinsky’s Rules for Radicals.

 
 

Clipped from: https://www.thesheridanpress.com/news/local/legislators-explain-medicaid-opposition/article_8995bad2-8e0d-11ed-a768-fbdd0e82c10e.html

 
 

SHERIDAN — Three Sheridan County state legislators explained their opposition to Medicaid expansion during a pre-legislative luncheon hosted by Sheridan County Chamber of Commerce Wednesday. 

Sen. Dave Kinskey, R-Sheridan; Rep. Cyrus Western, R-Big Horn; and Rep. Ken Penderraft, R-Sheridan; were the three legislators present out of the full Sheridan County delegation. Sheridanite Cathi Kindt asked legislators, “If there were a solid business case for Medicaid expansion, would you support it?”

All three legislators said no, but for varying reasons. 

“This thing has been brought up like eight times in the last couple of years,” Pendergraft said. “The answer to your question, ma’am is no. Even if he could show me that it would make Wyoming a great deal of money, I’m opposed. And the reason that I’m opposed is also philosophical. With liberty comes responsibility. If I cede responsibility, I give up some of that liberty, and on that philosophical basis, I would be opposed.”

Pendergraft believes there’s already too much governmental involvement in health care already and believes there should not be more. 

Western said he also does not prescribe to Medicaid expansion for philosophical reasons. 

“Are people fundamentally entitled, at a constitutional rights level, to free health care?” Western posed. “I understand the the reasoning and the rationale behind it, I really do, to the extent that it makes sense, but everything costs something. And so given how expensive it is, given how much money we’d have in debt. Those are my biggest concerns. It’s not that I can’t appreciate the benefits that it brings.”

Kinskey said other states reported costs well beyond what was budgeted and the federal government not coming through with its promises to help pay for expansion. 

“They end up being a budget buster everywhere it’s adopted,” Kinskey said. “…So if we adopted Medicaid expansion and the Feds did not keep their word and they went to spend to paying half like they do on all the other Medicaid, that difference is equal to the maintenance on every school in the state of Wyoming for a year.”

“Budget-wise, I just don’t think that this case can be made (for Medicaid expansion),” Kinskey said. 

Four bills are currently listed that address aspects of Medicaid: Medicaid twelve month postpartum coverage; medical treatment opportunity act-Medicaid reform; Medicaid coverage-licensed pharmacists; and podiatry medical services-Medicaid. To read the bills, see wyoleg.gov. 

The general session begins Jan. 10 in Cheyenne. 

MM Curator summary

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.

 
 

[MM Curator Summary]: Another good example of the use of Rule #8 from Alinsky’s Rules for Radicals.

 
 

 
 

Clipped from: https://www.northcarolinahealthnews.org/2023/01/11/this-state-could-be-the-last-one-for-a-while-anyway-to-expand-medicaid/

Stateline/ Pew Trusts

For years, state Sen. Phil Berger says, there was nobody in North Carolina who opposed Medicaid expansion under the Affordable Care Act more vehemently than he did.

“If there was somebody in the state of North Carolina that had spoken out publicly in opposition to Medicaid expansion more than me, I’d like to talk to that person,” Berger said in an interview last month. From the time the ACA passed in 2010 until last spring, “my attitude was Medicaid expansion was wrong for North Carolina,” he said.

Berger, a Republican, is president pro tempore of the North Carolina Senate, the most powerful position in the chamber, so his opposition virtually guaranteed that the legislature would not expand the joint federal/state program to include an additional 600,000 adults with low incomes.

That’s why Berger’s recent conversion from opponent to proponent has shot North Carolina to the top of the list of the states that are most likely to break ranks with the other 10 that have refused to expand Medicaid.

But it’s hard to imagine the other states doing the same anytime soon, which means that an estimated 6 million Americans will continue to be denied coverage.

In November, South Dakota became the 39^th state to approve expansion under the ACA, but it did so by a citizen-initiated ballot measure over the opposition of the state’s GOP governor and legislative leaders. Six other states also have expanded Medicaid that way. But among the holdouts, only Florida allows that option, and the pathway is so arduous there that proponents recently postponed their campaign for two years.

“We’re pretty close to the end” of expansion by way of citizen initiatives, said Kelly Hall, executive director of The Fairness Project, a national organization created to promote Medicaid expansion and other progressive goals through ballot initiatives.

Of course, it’s possible that GOP leaders in the remaining states, the largest of which is Texas, could have a change of heart like Berger did.

The North Carolinian said he had three objections to expansion: He feared that extending Medicaid coverage might discourage people from seeking work; he worried that the federal government could one day renege on its pledge to cover 90% of the cost of expansion, leaving states holding the bag; and he was concerned about adding to the unpredictability of North Carolina’s wildly fluctuating Medicaid expenses.

That last issue was resolved in 2021 with North Carolina’s transition to a Medicaid managed care system, which Berger says has made expenditures much more predictable. He abandoned his first objection, he said, after coming to realize that most of the younger, nondisabled adults who would be covered under expansion have jobs, are caregivers or are students.

As to the federal government backing out of its commitment on the federal match, Berger noted that it hasn’t done so under Democratic or Republican presidents, or with either party in control of Congress. “It ain’t going to happen,” he said.

Inducements for expansion

When former President Barack Obama signed the Affordable Care Act in 2010, it included a requirement that states expand Medicaid to enable all adults with low incomes to enroll in the program. In 2012, however, the U.S. Supreme Court ruled that Medicaid expansion was optional for states. Nearly half the states and Washington, D.C., expanded in 2014, as soon as the new law allowed, and more followed.

States that rejected expansion turned down substantial inducements. In the original Medicaid program, the federal government pays anywhere from 50% to nearly 78% in matching funds depending on a state’s per capita income. (Congress temporarily raised that federal match rate during the COVID-19 public health emergency.) But under the ACA, the federal match to cover the Medicaid expansion population is 90% for every state.

States that expanded Medicaid experienced job growth, particularly in the health care sector, as a result of the federal largesse. Expansion also reduced the amount hospitals needed to pay for uncompensated care, which was particularly helpful for financially strapped rural hospitals, many of which have closed in the past two decades.

In 2021, in response to the pandemic, the Biden administration added another inducement for the holdout states: a 5 percentage point bump in their federal match under traditional Medicaid for two years. That amounts to hundreds of millions of dollars in extra funding for those remaining states. Florida, for example, would pocket nearly $4 billion of extra federal money if it expanded, according to an analysis by Manatt Health, a research, legal and consulting organization. Mississippi would get $739 million.

“We’re losing money [in Mississippi] every minute we don’t expand, not to mention the human cost,” said Brandon Jones, campaign manager for the Southern Poverty Law Center, which supports Medicaid expansion.

Among the holdouts, only Florida allows for a ballot initiative process that could be used to expand Medicaid. (Wyoming’s law does not allow initiatives involving revenue or appropriations, as a Medicaid expansion would.) But even in Florida, the legislature has made qualifying for a ballot initiative so difficult that backers of Medicaid expansion recently decided to try to get on the ballot in 2026 rather than 2024 as they initially had intended.

“Given the complexities we have here in Florida that you don’t see in other states, even though the will of the people of Florida is there for expansion, but we need time to gather the funds to run a successful campaign,” said Jake Flaherty, campaign director of Florida Decides Healthcare, which is leading the expansion effort.

Flaherty acknowledged that hostility toward expansion from Republican Gov. Ron DeSantis and GOP leaders in the legislature make it virtually unthinkable that an expansion bill could pass. The same is true in many of the other holdout states, including Texas, where recently reelected Republican Gov. Greg Abbott and Lt. Gov. Dan Patrick remain staunchly opposed. Even if privately sympathetic to expansion, GOP lawmakers in Texas are unlikely to cross their party’s state leaders.

Ballot foreclosed in Mississippi

Until recently, Mississippi seemed to be fertile ground for a successful ballot campaign. In fact, several years ago, proponents of expansion launched an initiative campaign with an eye toward getting on the ballot in 2022. But in 2021, the state Supreme Court threw out the state’s ballot initiative process. The ruling pertained to an initiative concerning medical marijuana, but it scuttled the Medicaid expansion ballot campaign.

There have been proposals in the Mississippi legislature to devise a new initiative process that can withstand legal challenge. But for now, proponents of expansion say they don’t see a pathway, and passage in the legislature would have to overcome the steadfast opposition of Republican Gov. Tate Reeves and state House Speaker Philip Gunn.

The state’s GOP leaders remain opposed despite the fact that a majority of Mississippians want to see Medicaid expanded, according to polls. Jones, of the Southern Poverty Law Center, who is a former Mississippi House member, says his private conversations with Republican lawmakers have convinced him that they largely feel the same way. But, he said, they are fearful of crossing their leaders on the issue.

With Gunn’s announcement that he will not run again for his seat, Jones said he believes the legislature will eventually pass expansion.

“Do we do it this year? Probably not. It’s an election year, and we still have a speaker and a governor who are opposed,” Jones said. “But anything big we’ve ever done in Mississippi seems to happen real quickly … that’s what happened with changing the state flag. So, this could be the year it happens with Medicaid expansion.”

Reeves’ office didn’t respond to a request for comment, and Gunn’s office said he wasn’t available for an interview.

In Wyoming, proponents drew encouragement from state House passage of a Medicaid expansion bill for the first time in 2021, but the measure ran aground in the Senate that year.

Proponents in Kansas also have been heartened by newly reelected Democratic Gov. Laura Kelly’s plan to make another run at expansion next year. Polls there too indicate strong support for passage, with more than 70% in favor. Kansas is surrounded by states that have expanded. (Kansas does not have a citizen ballot initiative process. Last August’s referendum in which Kansas voters chose to keep abortion protections in the state constitution was placed on the ballot by the legislature.)

Nevertheless, April Holman, executive director of Alliance for a Healthy Kansas, a coalition of 128 Kansas organizations working toward expansion, said the Republican legislature and its leaders have proved impervious to popular opinion — though pressure is rising.

“For me, I’m always hopeful or I wouldn’t be able to do this work,” Holman said. “But it requires building a movement that is too large and too loud to ignore and that’s what we’ve been trying to do.”

Neither the new Republican House speaker in Kansas, Daniel Hawkins, nor Republican Senate President Ty Masterson responded to Stateline requests for comment.

That leaves North Carolina as the most likely domino to fall next. And if it does, Berger will be one of the key players toppling it.

Berger single-handedly changed the political landscape for expansion by announcing his support last year, putting himself alongside Democratic Gov. Roy Cooper, who has long advocated for expansion. The Senate passed expansion overwhelmingly in its 2022 session, but the bill failed to pass in the House, not because of objections to expansion itself but because of a provision that would have made it easier to create new health facilities or services in the state, which the hospital industry opposed.

Last year’s legislative session was the shorter one in its two-year cycle. As a result, Berger said, the House and Senate didn’t have time to negotiate their differences on the bill. This year, lawmakers will have more time, and Berger said he is optimistic about reaching a different result.

“I have told folks that I felt like by the time the two-year session is over, North Carolina will have expanded Medicaid,” he said. “There’s a deal in there somewhere.”

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This state could be the last one (for a while, anyway) to expand Medicaid

by Pew Trusts, North Carolina Health News
January 11, 2023

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