Medicaid Expansion Debate Continues as States Consider Waiver Options

In the 25 states that opted to participate in the Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), the newly eligible, childless, nondisabled adults between the ages of 19 and 64, can now be covered. In the others, parents who are not eligible under the state plan and those childless, nondisabled adults are out of luck. But a few continue to debate, and some of these states recently have been looking at using demonstration program waivers to get at least some of the benefit that residents of other states receive.

Wisconsin Waiver

CMS granted Wisconsin’s “Badger Care Reform” waiver by letter dated December 30, 2013.  Nondisabled childless adults with incomes up to 100 percent of the federal poverty level (FPL)  will be eligible for Medicaid. Parents and caretaker relatives who are eligible only for transitional medical assistance (TMA) (temporary assistance after an increase in income  due to employment) may be required to pay premiums after six months of coverage if their incomes are over 100 percent of FPL and if they are not eligible under any other category. Beneficiaries receiving TMA whose incomes exceed 133 percent of FPL may be charged premiums as of the first day of TMA. Premiums will be consistent with the marketplace premiums. The federal match will be at the state’s regular rate rather than the 100 percent that would be available if the state had adopted the Medicaid expansion.

Wyoming Debate

The Wyoming legislature is still actively considering expansion. A legislative committee heard testimony on January 9, 2014. The committee ahs since voted to sen two bills to the full legislature, one for  expansion with more limited benefits than regular Medicaid, and another that would subsidize premiums for private insurance.

New Hampshire Vote

On January 8, 2014, the New Hampshire House of Representatives passed a bill to expand Medicaid under the ACA. The bill would provide assistance through the state’s managed care plan. Negotiations between Senate Republicans and Democrats continue.

Pennsylvania’s Proposed Waiver

Pennsylvania Governor Tom Corbett proposes to reform Medicaid as part of any expansion. The state would charge premiums on a sliding scale. Family coverage for beneficiaries with incomes of at least 133 percent of FPL would cost $35 per month.Corbett also would add a work search requirement for unemployed beneficiaries. The state completed the hearings required for the waiver application on January 8, 2014.

Indiana and Missouri

Democratic legislatures in both states continue trying to persuade their colleagues to vote for expansion.In Indiana, state  Senator Karen Tallian (D-Ogden Dunes) has announced that she plans to introduce two bills. Her “Just Say Yes” bill would accept the Medicaid expansion under the ACA. A second bill would offer premium assistance.

Missouri’s Democratic governor, Jay Nixon, has fought a losing battle with the Republican-controlled legislature. Observers describe the prospects for expansion as slim.