GOP gov­er­nors to of­fer ideas on fu­ture of Med­i­caid ex­pan­sion

Modern Healthcare - - THE WEEK AHEAD - —Har­ris Meyer

Repub­li­cans on the Se­nate Fi­nance Com­mit­tee may get an ear­ful Thurs­day from Repub­li­can gov­er­nors about con­gres­sional plans to re­peal the Af­ford­able Care Act’s Med­i­caid ex­pan­sion and cap the pro­gram’s fund­ing.

Fi­nance Com­mit­tee mem­bers have sched­uled a roundtable dis­cus­sion on what gov­er­nors want to see in a plan to re­place the ACA and how to give states more flex­i­bil­ity in run­ning Med­i­caid. But at least five of the 16 Repub­li­can gov­er­nors of large states that ex­panded Med­i­caid to low­in­come adults have come out against end­ing the ex­pan­sion with­out of­fer­ing a way to keep mil­lions of their res­i­dents in­sured. Some have said the ex­pan­sion dol­lars have helped their states ad­dress the opi­oid ad­dic­tion and be­hav­ioral health crises.

In 2016, the 31 states that ex­panded Med­i­caid re­ceived $72 bil­lion in ex­tra fed­eral dol­lars due to the ex­pan­sion. “Those gov­er­nors are find­ing that hun­dreds of thou­sands of ad­di­tional peo­ple have come into cov­er­age, and the fi­nanc­ing is baked into their bud­gets,” said Deborah Bachrach, a part­ner at Manatt Health and for­mer Med­i­caid di­rec­tor of New York. “Af­ter you pull out the funds, you are left with a bud­get hole.”

House Speaker Paul Ryan wants to sharply re­duce the fed­eral con­tri­bu­tion for the ex­pan­sion pop­u­la­tion. But seven states have laws re­quir­ing ter­mi­na­tion of their ex­pan­sions if the fed­eral match drops, she noted. The rest would have a tough time keeping their ex­pan­sions due to bud­get pres­sures.

In ad­di­tion, the GOP gov­er­nors Thurs­day are likely to of­fer cau­tions about their party’s plan to con­vert Med­i­caid from an en­ti­tle­ment to a pro­gram of capped fed­eral con­tri­bu­tions to the states, ei­ther in the form of block grants or per capita pay­ments. That would give states much greater flex­i­bil­ity to set el­i­gi­bil­ity and ben­e­fits.

“All gov­er­nors would like more flex­i­bil­ity,” Bachrach said. “But the con­cern that’s start­ing to emerge is, are the ad­di­tional flex­i­bil­i­ties worth the trade-off of fewer fed­eral dol­lars?


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