Medicaid Expansion

Just a week ago, I posted...

I strongly suspect that at least one of the remaining holdout states will join the expansion crowd this year, most likely Georgia, Mississippi or Alabama...but it likely will be some state-specific variant as described above. Stay tuned...

And just a few hours ago, I posted a piece headlined, "Which Holdout State Will Be Next To Finally Expand Medicaid??"

Well, it looks like we may have our answer already. Via Ashton Pittman of the Mississippi Free Press:

A Medicaid expansion bill will arrive in the Mississippi Senate by Monday, beginning a process that could provide health care to about 230,000 working Mississippians, Lt. Gov. Delbert Hosemann says.

via the North Carolina Dept. of Health & Human Services:

NC Medicaid Expansion Continues to Bring Health Care to More North Carolinians

PRESS RELEASE — As of Feb. 1, 2024, 346,408 newly eligible North Carolinians are enrolled in Medicaid and now have access to comprehensive health care, according to the North Carolina Department of Health and Human Services’ Medicaid Expansion Enrollment Dashboard. NCDHHS released an updated the dashboard today, and it includes enrollment data as of Feb. 1, 2024. This number is more than half of the anticipated 600,000 people who are newly eligible for coverage, expected to enroll in Medicaid expansion over the next two years.

"In the first two months we have already enrolled over half of the eligible people," said NC Health and Human Services Secretary Kody H. Kinsley. "These individuals and families are seeing providers, utilizing preventative and specialty care, and getting life-saving prescriptions."

Georgia is one of just ten remaining states which is still holding out on fully expanding Medicaid to all legal residents earning up to 138% of the federal poverty level under the Affordable Care Act. Instead, back in 2019, GOP Georgia Governor Brian Kemp submitted a Section 1115 waiver which included a plan to partially expand Medicaid to some uninsured Georgia residents...except with a work reporting requirement for enrollees attached to it.

The program was called "Georgia Pathways," it was approved by the Trump Administration, and unlike several other states which had work requirement provisions shot down by various judges, Georgia's managed to slip through. It was scheduled to go into effect in 2021 and was supposed to be valid until September 30, 2025 before having to be resubmitted for renewal.

The incoming Biden Administration's HHS Dept. put the kibosh on the work requirement provisions of the program. Georgia successfully challenged the administration and Georgia Pathways went into effect last summer...but is still currently scheduled to sunset next September.

Back in November, I noted that Georgia, one of the ten states STILL refusing to expand Medicaid coverage to hundreds of thousands of low-income residents a decade after they could have done so under the ACA, may finally be coming around...albeit via a rather silly & inefficient method. via the Atlanta Journal-Constitution:

Could Georgia adopt an Arkansas-style Medicaid plan?

Senior Republicans see an opening for a health care overhaul

Key Republicans say they’re open to legislation that would add hundreds of thousands of poor Georgians to the state’s Medicaid rolls — and bring in billions of federal dollars to subsidize it — as part of a compromise to roll back hospital regulations.

I just posted a colorful graph which tracked ACA Qualified Health Plan (QHP) enrollment over eleven years of Open Enrollment Periods.

Below I've done the same thing for ACA Medicaid Expansion. The data comes from the Centers for Medicare & Medicaid Services quarterly Medicaid Budget & Expenditure System reports.

*Unfortunately the MBES reports only run through June 2023, so it's missing 6 months of updates (which have likely shown a small drop in ACA Expansion Medicaid enrollees due to the ongoing Unwinding process). It therefore actually only includes 10 1/2 yrs of enrollment data.

Also keep in mind that if the remaining 10 states had expanded Medicaid under the ACA by now, the grand total would have been several million higher.

No further analysis or comment here; I just think this is a pretty cool graphic...and keep in mind that most of the ~24.5 million people represented here would have been utterly screwed from early 2020 - early 2023 without the Affordable Care Act being in place when the pandemic hit. Click the image for a higher-resolution version; the states are listed on the right-hand side, though they might be difficult to make out (also note that Guam, Puerto Rico and the U.S. Virgin Islands also have a number of ACA expansion enrollees shown):

Mississippi is one of the ten states where ACA Medicaid expansion still hasn't gone through a full decade after it could have.

A few years ago, Medicaid expansion in Mississippi looked like it might actually happen: While the states GOP Governor and Republican supermajority-controlled state legislature opposed it, in May 2021 there was a strong grassroots effort to put a statewide initiative on the ballot to push it through regardless, exactly how it happened in other deep red states like Utah, Nebraska, Idaho and South Dakota.

Unfortunately, just a few weeks later, the Mississippi Supreme Court crushed that effort:

Back in September, Inside Health Policy reporter Dorothy Mills-Gregg checked in on "Georgia Pathways," the Peach State's new program which partially expands Medicaid to residents earning up to 100% of the Federal Poverty Level (FPL), but with a rather significant string attached: Work reporting requirements:

As noted by Madeline Guth of the Kaiser Family Foundation last year:

...in spite of nearly every state which tried to (or succeeded in) implement Medicaid work requirements having their programs shut down by the courts, one state's work/reporting managed to survive: Georgia. As explained in the Kaiser article:

It was just 53 days ago that North Carolina became the 40th state (plus DC & the U.S. territories) to fully expand Medicaid under the Affordable Care Act. At the time, around 600,000 lower-income North Carolinians were estimated to be eligible for the public healthcare program.

So where do things stand now? Well, the NC government has posted a handy Medicaid enrollment dashboard which is tracking the data as once a month; the most recent update was on January 12th:

NC Medicaid Expansion Enrollment as of January 12th, 2024: 314,101

The dashboard has some nifty interactive tools letting. you filter enrollees out by plan, age bracket, gender, ethnicity, urban/rural status and county, along with enrollment trends.

For ten years now, I've had Google Alerts set up to send me links to stories about the Affordable Care Act using various commonly-used phrases like "health exchanges" and such. Normally these bring up the most recent articles about the law, but last night one of them included a surprising link to a Reuters article from...March 2013:

Washington could wind up running more health exchanges - official

March 14, 2013

...The Obama administration has given 17 of the 50 states conditional approval to set up online exchanges where working families would purchase private plans at subsidized rates. The remaining 33 states will all have federally run markets, at least in the early years of the coming reform era.

But Gary Cohen, who spearheads exchange implementation for the U.S. Department of Health and Human Services, said some of the approved states face hurdles that could require Washington to step in with federal exchanges before open enrollment starts on Oct. 1.

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