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Medicaid

I used to write about Kentucky quite a bit shortly after incoming GOP Governor Matt Bevin made good on his promise to disassemble their beloved and award-winning "kynect" state ACA exchange. I haven't written much about the state since then, however, until now.

Bevin made two major campaign promises while running to replace former Democratic Governor Steve Beshear (who expanded Medicaid and established kynect via executive order): He said he'd kill kynect and get rid of ACA Medicaid expansion. He stuck to his guns on the former, and while it's a damned shame that he did so for a number of reasons (it was working perfectly well, had a high public image and awareness, etc), it didn't cause too much damage, since KY simply shifted to the federal exchange instead (HealthCare.Gov). Enrollment did drop off by over 13% year over year, but a few other states saw similar drops, so the move probably wasn't a major factor.

Every month I post an entry about the official CMS Medicaid enrollment report, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees.

As of August 2016, total Medicaid enrollment continued to quietly increase for a total of 73.1 million people, with 15.7 million of that being mainly due to the ACA (~11 million via official expansion, ~1 million early additions/transfers and ~4 million "woodworkers").

HOORAY! FACE-EATING LEOPARDS FOR EVERYONE!!

I don't write a whole lot about Medicare, since just about all U.S. citizens over 65 are covered by it and therefore don't enroll via the ACA exchanges anyway. However, it does come up on this site from time to time, and a good 55 million or so are enrolled in the program, so this little story might be of some relevance:

Every month I post an entry about the official CMS Medicaid enrollment report, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees.

As of July 2016, total Medicaid enrollment continued to quietly increase for a total of 72.8 million people, with 15.4 million of that being mainly due to the ACA (~10 million via official expansion, ~1 million early additions/transfers and ~4 million "woodworkers").

Regular readers know that I used to regularly post an entry about the official CMS Medicaid enrollment reports every month, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees.

As of November 2015, there had been a net increase of 14.1 million people added to the Medicaid rolls since October 2013 (the month when ACA expansion enrollment began), plus another 950,000 people who had already been quietly transferred over to Medicaid from existing, state-funded programs prior to 2013 via other ACA provisions. I sort of forgot to post about the reports for awhile, but checked back in again for the May report, released back in July.

Regular readers know that I used to regularly post an entry about the official CMS Medicaid enrollment reports every month, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees.

In fact, I realized this morning that I got so caught up in other ACA stories earlier this year that I haven't even posted a monthly update once since last November!

As of November 2015, there had been a net increase of 14.1 million people added to the Medicaid rolls since October 2013 (the month when ACA expansion enrollment began), plus another 950,000 people who had already been quietly transferred over to Medicaid from existing, state-funded programs prior to 2013 via other ACA provisions.

From an AccessHealthCT press release:

ACCESS HEALTH CT PROVIDES TRANSITIONAL MEDICAL ASSISTANCE ENROLLMENT UPDATE
2,846 individuals have enrolled in a new healthcare plan

Hartford, Conn. (July 8, 2016) - Access Health CT (AHCT) CEO Jim Wadleigh provided an update today on enrollment of approximately 13,811 parents and caregivers who will lose their Transitional Medical Assistance (TMA) on July 31st when they no longer meet the HUSKY A eligibility requirements due to a change in legislation last year. As of July 7, 2016, 2,846 individuals have enrolled in a new healthcare plan via the exchange. Of those, 1,966 applications have been re-determined eligible for coverage in a HUSKY program through the integrated eligibility system with the Department of Social Services, and 880 have enrolled in a Qualified Health Plan (QHP) with AHCT.

Amazing, but utterly predictable:

Despite bitter resistance in Oklahoma for years to President Barack Obama's health care overhaul, Republican leaders in this conservative state are now confronting something that alarms them even more: a huge $1.3 billion hole in the budget that threatens to do widespread damage to the state's health care system.

So, in what would be the grandest about-face among rightward leaning states, Oklahoma is now moving toward a plan to expand its Medicaid program to bring in billions of federal dollars from Obama's new health care system.

What's more, GOP leaders are considering a tax hike to cover the state's share of the costs.

"We're to the point where the provider rates are going to be cut so much that providers won't be able to survive, particularly the nursing homes," said Republican state Rep. Doug Cox, referring to possible cuts in state funds for indigent care that could cause some hospitals and nursing homes to close.

About a year ago I wrote about a bill working it's way through the California state legislature which, if passed and signed into law, would have allowed all of California's 1.5 million uninsured, undocumented immigrants to either enroll in Medi-Cal (CA's name for Medicaid) or in ACA exchange policies via Covered California (with the state picking up the tab for the APTC/CSR financial assistance). Since the ACA specifically prohibits any federal dollars from being used, the state would be on the hook for 100% of the cost.

The bad news is that this ambitious bill didn't end up making it through the process. The good news is that a stripped-down version of it did become law:

(thanks to Hector Solon for the tip)

OK, as far as crimes and/or stupidity by the Michigan GOP goes, this is pretty small potatoes these days. Even so...

So, you may have heard that the Republican-controlled Michigan state legislature recently passed (and Governor Rick "Leadfoot" Snyder signed) a dead-of-night bill which, for absolutely no reason whatsoever...

...bans any public body or public official, except for “an election official in the performance of his or her duties,” from using public funds to issue any kind of communication that “references a local ballot question, and is targeted to the relevant electorate where the local ballot question appears on the ballot,” in the 60-day run-up to an election.

The official CMS November 2015 Medicaid/CHIP Enrollment Report has been released, and the net enrollment increase due to the ACA continues to quietly increase, passing the 14 million mark (or, arguably, hitting 15 million, depending on your POV):

  • Nearly 71 million individuals were enrolled in Medicaid and CHIP in November 2015. 7 This enrollment count is point-in-time (on the last day of the month) and includes all enrollees in the Medicaid and CHIP programs who are receiving a comprehensive benefit package.

This number is about 900K lower than October's report (71.8 million) due to a reporting correction in California:

I somehow managed to completely miss the September Medicaid report released last month, but it turned out to be a virtual non-issue; there was a net increase of just 2,599 people enrolled in Medicaid nationally from the end of August through the end of September 2015.

In October, however, things picked up; while not nearly the half-million-plus-per-month that we saw during 2014 and the first half of this year as the bulk of ACA Medicaid expansion went into effect in most states, the total number of people enrolled in the program did still increase by a respectable 187,958 people month over month.

This has resulted in a net enrollment increase of over 13.5 million people since the ACA expansion program went into effect two years ago, and a grand total of 71.8 million enrolled in the program nationally.

A Twitter discussion with Andrew Sprung, along with my own prior grumbling about this issue, led me to actually compile the following list of just what "Medicaid" is actually called in each state.

Our discussion was specifically about some seemingly odd data he found in the U.S. Census Bureau's official healthcare coverage report released the other day; he was perplexed as to how come poor people seemed to increase their rate of private healthcare coverage while less-poor people increased their publicly-funded coverage, which seems rather backwards. In any event, one of the reasons noted by myself and "HotWxTakes" is that it's likely that a large number of those responding to the survey may have simply gotten confused as to whether their own coverage falls into the "private" or "public" category...most notably, confusion over "Medicaid". As I noted, "Medicaid" is operated at the state level, not federal, and is run under different names in different states, making some amount of confusion understandable.

Last year, GOP Governor Tom Corbett pushed through a poorly-conceived, overly-cumbersome "Republican alternative" Medicaid expansion program called Healthy PA, which didn't go into effect until late in the year. He was defeated by Democrat Tom Wolf, who vowed to scrap the "alternative" version and simply expand Medicaid to residents below 138% of the Federal Poverty Level, as the ACA had intended.

This transition was messy, but has now been completed...and is saving the people of Pennsylvania a boatload of money:

Department of Human Services Sec. Ted Dallas Tuesday announced the end of the transition from Healthy PA to traditional Medicaid expansion—known as HealthChoices in Pennsylvania—as the last of the expansion insurance plans took effect.

According to Sec. Dallas, 440,000 Pennsylvanians are enrolled in Medicaid expansion insurance plans with the last group of enrollees coming out of Healthy PA’s primary coverage options into Medicaid expansion.

“With that last group of folks moving over, the Medicaid expansion is now complete,” Sec. Dallas told reporters.

Twenty-seven Alaskans were approved for benefits under Medicaid expansion Tuesday, the first day of the broadened health care program, the state Department of Health and Social Services announced Wednesday.

According to state officials, about 40,000 people are potentially eligible for the expansion program, although as Xpostfactoid pointed out a month or so ago, the Kaiser Family Foundation has a much lower estimate (more like 11,000).

Either way, the actual number enrolled or in the process is quite a bit higher than just 27...

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