Indiana Adds Work Requirement To Medicaid, Will Block Coverage If Paperwork Is Late
PHIL GALEWITZ
Indiana on Friday became the second state to win federal approval to add a work requirement for adult Medicaid recipients who gained coverage under the Affordable Care Act. A less debated provision in the state's new plan could lead to tens of thousands of people losing coverage if they fail to complete paperwork documenting their eligibility for the program.
The federal approval was announced by Health and Human Services Secretary Alex Azar in Indianapolis.
Medicaid participants who fail to promptly submit paperwork showing they still qualify for the program will be locked out of enrollment for three months, according to updated rules.
Gov. Matt Bevin has issued an executive order that would strip Medicaid coverage from nearly half a million Kentuckians should his proposed overhaul of the federal-state health plan be struck down in court.
No one has filed a legal challenge to Bevin's changes to Kentucky's Medicaid program that federal authorities approved Friday.
But several advocacy groups have said some of the changes — such as requiring some "able-bodied" adults to work or volunteer at least 20 hours a week — likely will be challenged in court because they violate federal law that establishes Medicaid purely as a health program and does not authorize work requirements.
With the big news this week about CMS giving work requirements the green light and Kentucky immediately jumping all over it, I decided to look up a few data points from some expansion states which don't include a work requirement for the heck of it:
As of January 8th, 2018, Michigan had 669,362 adults enrolled in the "Healthy Michigan" program (aka, ACA Medicaid expansion), or over 6.7% of the total population.
Men make up slightly more enrollees than women (51% to 49%)
Enrollees are spread fairly evenly by age brackets (19-24, 25-34, 35-44, 45-54 and 55-64)
Around 80% of MI expansion enrollees earn less than 100% of the federal poverty line; the other 20% earn between 100-138% FPL.
*UPDATE: Some have accused me of hyperbole in the headline because a) it's a "state-approved health or financial literacy" course, not a "can you read" test and b) because it would only be required if they're unable to meet the requirements in other ways. I guess I can see their point, but it strikes me as splitting hairs:
First, "literacy course" was their wording, not mine (I guess there's a distinction between "completeing a course" and "passing a test"?).
Second, there doesn't appear to be any real description of the "courses" in question--how long it is, what the criteria for measuring "completion" is, who would be conducting the course, whether you'd have to attend classes in person (vs doing so online?), how many sessions there'd be and so forth. Here's the description as laid out in the waiver request itself:
I used to track the monthly Medicaid/CHIP enrollment reports issued by CMS, watching as the numbersrosedramatically thanks to ACA Medicaid expansion.
I pretty much stopped doing that about a year ago, however, since the expansion numbers have mostly petered out. ACA Medicaid expansion actually has continued to climb a bit more since January, and is likely somewhere around 16 million people as of now, but it's also been partly cancelled out by a slight drop in standard Medicaid enrollment as the economy has continued to improve in general. In short, there's little reason to keep writing the same update every month.
Maine voters on Tuesday decided to expand Medicaid to cover more low-income adults, becoming the first state to do so through a referendum.
Support for the ballot measure was up by more than 18 points with 64 percent of precincts reporting about 10 p.m. when it was called by NBC affiliate WCSH and The Associated Press.
The results in Maine, one of 19 states that rejected Medicaid expansion under the Affordable Care Act, comes as other Republican-led states like Utah and Idaho eye similar ballot measures.
Advocates of Medicaid expansion in Maine successfully petitioned the state to include a question on this year’s ballot following several failed legislative efforts to expand the program.
I've embedded screen shots below, but there's various interactive stuff you can do at the site itself; LA did a very nice job, I'd love it if every state put up a similar "dashboard" style website.
In short:
434,594 Louisianans enrolled in Medicaid via ACA expansion
126,229 have received preventative care
22,058 women have received breast cancer screenings
225 women have been diagnosed with breast cancer as a result of ACA Medicaid expansion
13,994 adults have received a colon cancer screening
4,337 have averted colon cancer by having polyps removed
199 have been diagnosed with colon cancer thanks to ACA Medicaid expansion
3,774 have been diagnosed with diabetes
9,575 have been diagnosed with hypertension
32,912 are receiving outpatient mental health services
6,025 are receiving inpatient mental health services
5,559 are receiving outpatient substance abuse services
6,026 are receiving residential substance abuse services
As health care debate simmers, Mead laments lack of Medicaid expansion in Wyoming
Gov. Matt Mead lamented the $100 million that Wyoming left on the table by choosing not to expand Medicaid, and he expressed concern for the state’s hospitals while discussing health care with the Star-Tribune recently.
Mead echoed some of the fears that many Wyoming hospital officials have expressed for months: that congressional proposals to overhaul the health care system may have negative effects on facilities here and that the state has suffered because it chose not to allow more people to qualify for Medicaid.
“The idea that we did not accept Medicaid expansion and things are going to be good just hasn’t turned out,” he said.
As regular readers know, I've been a bit obsessive about tracking down and breaking out ACA Medicaid expansion enrollee numbers. This is more difficult than it sounds, because most Medicaid reports lump expansion enrollees in with the other ~58 million or so Medicaid enrollees; only a handful of states issue separate reports of the expansion-specific population on a regular basis.
Back in late November, I cobbled together the data as best as I could and came up with a total of roughly 11.3 million people nationally. However, that included a lot of 2-year old data and rough estimates.
A couple of weeks later, I stumbled upon a detailed analysis from an anti-ACA financial watchdog organization, the Foundation for Government Accountability, which provided hard numbers and confirmable data source links which included more recent numbers for many states. This brought the total up to over 12.3 million.
Of the 31 states which have expanded Medicaid under the Affordable Care Act, only a handful issue regular monthly or weekly enrollment reports.
Back on February 28th I noted that ACA Medicaid expansion enrollment across three states (Michigan, Louisiana and Pennsylvania) had grown by about 35,000 people since mid-January, to 667K, 406K and 716K people respectively.
Today, a month later, I decided to take another look at all three states, along with Minnesota (which I forgot to check last month). Sure enough, enrollment has continued to grow in all four, albeit at a slower pace:
