Apr. 3—A majority of states have approved an expansion of Medicaid, even as new fault lines have appeared in the four-year-old expansion fight.

New Hampshire was the 26th state to approve a Medicaid eligibility expansion authorized by the Affordable Care Act (ACA), according to the Kaiser Family Foundation. Gov. Maggie Hassan signed the expansion into law on March 27.

The model followed by New Hampshire was similar to one first popularized by Arkansas, where a Democratic governor was able to garner Republican legislators’ support through an approach that used Medicaid federal funds to provide enrollee coverage through the new ACA marketplaces.

About 38,000 people are expected to be added to New Hampshire’s Medicaid managed care program on July 1—before the state moves them to private insurance in 2016, according to local news reports. The move into private coverage requires approval of a waiver by the Obama administration.

The administration is balking at approving another version of the Arkansas plan proposed by Pennsylvania Gov. Tom Corbett, a Republican. That plan also would provide Medicaid expansion coverage through the exchange, but would require monthly premium payments and work search.

Opposition Emerging

The proposed changes in Pennsylvania are unusual because they have generated opposition from some advocates of the Medicaid expansion, who supported previous versions of the so-called Arkansas model.

For instance, Joan Alker, a Medicaid expert at Georgetown University and an expansion proponent, recently joined other advocates in opposing the Pennsylvania expansion plan.

Her concerns included “the imposition of premiums for those above the poverty line, which would be significantly higher than those in the marketplace at similar income levels; the request to waive all wrap around benefits for newly eligible beneficiaries who would be served by ‘private insurance;’ the request to cut benefits for current beneficiaries, and the vague and open-ended nature of many of the state’s requests,” Alker wrote in a March 28 blog post.

Meanwhile, the state hospital association and other provider advocacy groups have supported the plan.

“Since the introduction of the Healthy Pennsylvania initiative, [the Hospital and Healthsystem Association of Pennsylvania] has been engaged in productive conversations with the Corbett administration to refine the details of the state’s proposed Healthy Pennsylvania 1115 Demonstration Application,” Andy Carter, president and CEO of the Hospital and Healthsystem Association of Pennsylvania, said in a written statement. “As a result of these discussions, we fully support the final document, as it offers an effective and workable program to address the health care and wellness needs of low-income Pennsylvanians.”

The expansion of Medicaid eligibility to all residents with incomes up to 138 percent of the federal poverty level was a central component of the ACA and one strongly pushed by hospital and other provider organizations to reduce their numbers of uninsured patients. But lack of support in 24 states for even a modified expansion was expected to leave about 15 million uninsured and underinsured, according to a recent Commonwealth Fund study.

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter @rdalyhealthcare.


Publication Date: Thursday, April 03, 2014