Supporters of Medicaid expansion in Utah said this week they had raised enough signatures to get the question before voters in November.
Two other traditionally Republican states — Nebraska and Idaho — could also see ballot initiatives on expansion this year as the battle for healthcare reform shifts more to the state level.
- Meanwhile, Arizona requested a section 1115 waiver from CMS that would allow the state to stop Medicaid recipients from getting retroactive coverage up to three months before a person applies for coverage. If approved, providers wouldn't be able to submit claims for services rendered in previous months, which is currently the case.
The Fairness Project, which backs the Utah Medicaid expansion project with Utah Decides Healthcare, said expanding Medicaid would provide coverage for 127,000 people in the state. State legislators also want to expand Medicaid, but at a smaller level than required by the Affordable Care Act (ACA). CMS is currently reviewing the state's waiver request.
Maine is the only state that has approved Medicaid expansion by ballot initiative. However, Republican Gov. Paul LePage is refusing to go forward without the state legislature providing funding that doesn't increase taxes or dip into reserves. Maine’s Health Department recently failed to meet an HHS deadline to provide the expansion plan to the agency.
Virginia could also become the next state to approve Medicaid expansion, as the Democratic governor supports the initiative and his party picked up seats in the legislature last year.
Meanwhile, Arizona is asking the federal government to allow the state “the flexibility to limit retroactive coverage to the month of application.” CMS approved a similar waiver from Iowa in October.
Arizona’s waiver request is called the Arizona Health Care Cost Containment System. The state said granting the waiver would encourage continuous health coverage and contain Medicaid costs. Arizona said the change could save the state $39 million in fiscal 2019.
However, changing the retroactive payment piece could hurt providers and hospitals. This program change could especially hurt safety-net hospitals, which rely on Medicaid reimbursements. Without three months of Medicaid retroactive coverage, providers may see more uncompensated care. The overall effect is hard to gauge because little evidence is available. As the Kaiser Family Foundation noted in November, "little is known about the impact of retroactive coverage waivers on beneficiaries and providers."
This state-level push and pull with the Medicaid program is where much of the healthcare reform debate is happening now. Congress failed to repeal and replace the ACA last year, though Republicans were able to kill the individual mandate penalty for 2019.
Rather than battling it out on Capitol Hill, both sides of the healthcare debate are working at the state level to expand Medicaid, protect it from cuts or rework the program. In addition to expansion projects, CMS has granted waivers to three states for work requirements for Medicaid recipients and more states are interested.
Earlier this month, CMS also issued a final rule that would allow states to select their own essential health benefits under the ACA.
New Jersey may become the second state with its own individual mandate. The bill awaits the governor’s signature. Maryland and California are also exploring that option.