Skip to main content
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Digital Health
    • Transformation
    • ESG
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • Newsletters
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Government
February 16, 2013 12:00 AM

There's a catch

GOP governors opt into expansion—but on their own terms

Rich Daly
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    AP PHOTO
    GOP Gov. John Kasich drew praise from Democrats and derision from Republicans after announcing plans to expand Medicaid to cover up to 684,000 more Ohioans.

    The Obama administration and healthcare reform advocates celebrated after a number of Republican-run states decided to expand Medicaid. Their celebrations may have been premature, however.

    The problem? Some of those expansions may run into opposition from the CMS.

    At least six Republican governors recently announced that they will drop their cost and control concerns to back the optional expansion of Medicaid eligibility for the uninsured earning between 100% and 138% of the income poverty level. But their support is contingent on using approaches that have drawn previous opposition from the Obama administration, such as health savings accounts and some types of premium support.

    “The conversation has turned from, 'I'm definitely not going to do it,' to 'Maybe I could do it if I got the flexibility for X,' ” said Matt Salo, executive director of the National Association of Medicaid Directors. “What X is is going to be different in every state.”

    Once the state plans are legislatively approved and signed by the governors, they will be forwarded to the CMS for approval, which can take different forms depending on the extent of the changes proposed for their Medicaid programs.

    Although details are still under development in many states where the governor has made the preliminary decision to move ahead with expansion, some potentially problematic elements have begun to emerge.

    For instance, Indiana's Republican Gov. Mike Pence proposed in a Feb. 13 letter to HHS Secretary Kathleen Sebelius to expand Medicaid to an additional 400,000 state residents, according to some estimates. However, the expanded coverage would have to occur through a Medicaid program—the Healthy Indiana Plan—that uses a version of health savings accounts, which may run counter to a recent federal ban on levying premiums on many Medicaid beneficiaries.

    “Our administration would predicate any expansion of Medicaid in Indiana on our ability to promote Hoosier innovation in the Healthy Indiana Plan to the expanded population,” Pence wrote.

    It is unclear whether the CMS even has the authority to issue a waiver allowing the Indiana approach because of the statutory ban, according to health policy experts. “This is really a question that CMS is going to have to answer,” said Judy Solomon, a vice president at the liberal Center on Budget and Policy Priorities.

    Complications may also arise in Ohio, where Republican Gov. John Kasich drew praise from Democrats and derision from Republicans for announcing plans on Feb. 4 to expand Medicaid to cover up to 684,000 more Ohioans, according to one analysis by the Urban Institute and the Kaiser Family Foundation.

    But emerging details indicate that the Ohio plan will include a premium assistance model, which has drawn opposition in the past from the Obama administration.

    Last January, HHS proposed rules allowing the use of premium assistance to help Medicaid and Children's Health Insurance Plan enrollees pay for coverage purchased from health insurance exchanges. Ohio's plan would use Medicaid funds to cover beneficiaries with incomes between 100% and 138% of the federal poverty level. However, it's unclear whether Ohio's proposal would fulfill the rule's caveats, which prevent higher nonpremium cost-sharing than Medicaid-eligible enrollees in exchange plans would otherwise be allowed to incur.

    “You really need a lot more details before you can evaluate it,” Solomon said.

    Virginia is another Republican-run state that may adopt a Medicaid expansion plan that runs afoul of federal laws or regulations, according to health policy experts. Even states with Democratic governors may advance problematic elements.

    The details will emerge only as legislatures in the states opting into the Medicaid expansion finalize and vote on their proposals in the coming weeks.

    CMS officials are expected to try to accept most proposals they are legally allowed to consider. The CMS did not respond to questions regarding its approval process.

    “I don't think they'll ultimately be accepted exactly as proposed, but there is a real interest in having a dialogue with states,” said Patricia Boozang, a managing director at Manatt Health Solutions.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    abortion-pill-misoprostol-legal
    Abortion pill case advances to appeals court, on course to Supreme Court
    young doctor medical resident
    Federal physician recruitment program at risk
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Modern Healthcare Alert: Sign up for this breaking news email to be kept in the loop as urgent healthcare business news unfolds.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Digital Health
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • ESG
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • Newsletters
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Jobs
      • People on the Move
      • Reprints & Licensing