Betsey Bayless, president and CEO of the Maricopa Integrated Health System, said executives called to argue their case with Brewer, and a group of providers hired a lobbying firm to press the business case for Medicaid expansion. The Phoenix-based system gets nearly two-thirds of its revenue from Medicaid. It risked losing the increased revenue from newly insured Medicaid patients and an estimated $80 million from adults who are expected to lose temporary coverage that was established in 2001, but scheduled to sunset Jan. 1, 2014, with the Affordable Care Act's Medicaid expansion, Bayless said.
In North Dakota, Republican Gov. Jack Dalrymple, who previously called the Affordable Care Act “wrong for North Dakota,” reversed his position and submitted a bill in early January to expand Medicaid.
Susana Martinez, New Mexico's Republican governor, also announced plans in early January to expand Medicaid. But the state will cut the most recent enrollees first if “the federal government breaks its funding promises,” Martinez said in a letter to state residents.
And Nevada Gov. Brian Sandoval likewise said he would pull back if the federal government doesn't carry as much of the burden as promised. The Republican said in December that he would expand Medicaid despite his dislike for the Affordable Care Act. He touted the expansion as a source of coverage for 78,000 residents who might otherwise face tax penalties under the law.
North Dakota's willingness and Arizona's embrace of the expansion—and its strategy to opt out without promised federal support—could help sway debate in South Dakota, said David Hewett, president and CEO of the South Dakota Association of Healthcare Organizations.
South Dakota Gov. Dennis Daugaard said in his budget address last month that without more information, he would not expand the state's Medicaid rolls this year, which he said would cost the state about $43 million to $44 million by 2020.
The federal government will cover the cost of newly eligible Medicaid enrollees through 2016. The following year, states will cover 5% of the costs, and their share rises to 10% by 2020. “We don't know what will happen after 2020,” Daugaard said. “Will the federal share remain at 90%? Will it drop to 80% or 70%?”
Daugaard noted that states have the option to delay the decision, suggesting the debates in South Dakota and elsewhere could drag on for years. The CMS in December said that the state could choose to broaden Medicaid eligibility later than 2014 and still draw the same level of federal funding, and that they may drop the coverage later.