Medicaid expansion options detailed in Leavitt report

Hospital officials still considering how to start “the dialogue”

0 | Health Reform, Medicaid-CHIP

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Robin Arnold Williams, Senior Advisor at Leavitt Partners.

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— The consulting firm headed by former Health and Human Services Secretary Mike Leavitt has delivered a report to the Kansas Hospital Association outlining what it considers might be politically viable options for expanding the Kansas Medicaid program to include thousands of additional people.

KHA Chief Executive Tom Bell confirmed he has a draft of the report and that discussions are underway about how best to use it. Broader release or public discussion of the options outlined in the report likely won’t come for at least a couple more weeks, he said.

The report describes how Kansas might use the private sector to expand Medicaid coverage to include people earning up to 138 percent of federal poverty guidelines.

The Kansas Medicaid program, called KanCare, currently is limited to the poor who are elderly or disabled. Eligibility rules for it are among the tightest in the nation and exclude childless, able-bodied adults altogether.

“It’s a really good overview of all of the options,” Bell said, noting the report stopped short of recommending a specific option.

“We believe the best kind of plan is one that policymakers and stakeholders put together themselves,” Bell said. “We’re trying to put together a structure for the dialogue.”

The state’s $3 billion KanCare program already relies heavily on private-sector involvement. Three for-profit, managed-care companies run the day-to-day operations. About 400,000 Kansans are enrolled in health plans managed by the insurance companies: Amerigroup, UnitedHealthcare and Sunflower State Health Plan, a subsidiary of Centene.

Robin Arnold-Williams, a partner in the Leavitt firm, and the former head of state social service agencies in Utah and Washington, said Kansas officials might want to consider options already adopted or being considered in other states.

“There are a range of (Medicaid expansion) choices and options that can be packaged together in different ways and each state has taken a little different approach to which pieces they select, how they put them together and for what populations,” she said, “We’ve also been reviewing alternative approaches and options that haven’t shown up yet either in (federally) approved waivers or legislation but are under discussion in various states.”

Some states are asking the federal Centers for Medicaid and Medicaid Services to let them require that enrollees who earn above the poverty level pay a portion of their premium. Others want to impose a work requirement or offer a different set of Medicaid benefits to new beneficiaries below the poverty level.

Arnold-Williams said she and Leavitt might come to Kansas to brief legislators and others on the options in the report. Leavitt, a Republican, served in President George W. Bush’s Cabinet and was a two-term governor of Utah.

She said Leavitt recently was in Arkansas to discuss that state’s expansion initiative with legislators.

Kansas is one of 23 states that have not chosen to expand Medicaid to include adults earning below 138 percent of the federal poverty line — $15,856 for individuals and $35,325 for a family of four.

That means an estimated 78,000 Kansans fall into the so-called “Medicaid gap.”

They are ineligible for Medicaid because they earn too much but are too poor to qualify for federal subsidies to help cover the cost of private coverage purchased in the new online marketplace created by the Affordable Care Act, more commonly known as Obamacare.

There has been a recent trend among once-reluctant Republican governors to embrace program expansion and hospital officials and other advocates for it had said they hope that spreads to Kansas.

Some plan to use federal Medicaid dollars to cover the cost of purchasing private coverage for the newly eligible beneficiaries.

At a recent question and answer session with Statehouse reporters, Kansas Gov. Sam Brownback said he wants to wait and see how much flexibility the federal government is willing to give states in the way they configure their expansions.

“The (Obama) administration is altering Obamacare on a weekly basis, so let’s watch and see what else they do,” Brownback said. “I frankly think that’s a prudent course.”

Some Kansas interest groups that opposed the Affordable Care Act now seem warmer to the idea of at least discussing Medicaid expansion, perhaps spurred by reports showing that without it Kansas medical providers could lose out on billions of dollars.

Mike O’Neal, head of the Kansas Chamber, said he would welcome discussion about how the state might move forward with a more private-sector approach.

“We don’t want to say ‘no, we’re not interested in this, let’s bury our head in the sand and not worry about it.’ This is an important issue and there needs to be a discussion,” O’Neal said.

O’Neal is a former Kansas House speaker and — like GOP leaders in the House and Senate — he said no plan likely will gain traction without Brownback’s urging.

“That’s probably what needs to happen,” he said.

KHI News Service coverage of Medicaid expansion

Medicaid Access Coalition launches online "ticker" showing foregone federal dollars (2/13/14)
→ KHI report: Nearly 182,000 Kansans in the ‘Eligibility Gap’ (1/11/14)
House speaker says Medicaid expansion is "up to the governor" (1/10/14)
KS Senate president says Medicaid expansion unlikely to gain approval this session (1/7/14)
Profiles of the coverage gap: Kathleen Christian (1/6/14)
Efforts continue to expand Medicaid in Kansas and Missouri (1/6/14)
Hospital association hires former Bush HHS secretary to help craft a plan Kansas Republicans might support (12/23/13)
Iowa wins approval to expand Medicaid by using federal funds to buy private insurance (12/11/13)
White House officials hold call to urge Medicaid expansion in Kansas (11/21/13)
Republican governor talks up plan to expand Medicaid — his way (10/28/13)
Challenger says Brownback owes voters a decision on Medicaid expansion (10/22/13)
Nearly 5.2M Americans fall in coverage gap in states not expanding Medicaid (10/16/13)
Sebelius: Feds flexible on how states expand Medicaid (9/22/13)
Sebelius says Kansas and Missouri are missing the boat on Medicaid expansion (9/20/13)
Medicaid expansion coalition finds strength in numbers (9/17/13)
Republican Gov. Corbett proposes expanding Pennsylvania Medicaid (9/16/13)
Kansas lawmakers urged to consider Medicaid expansion by Wesley CEO (8/29/13)
Estimating maneuver could help more people gain from Obamacare: How the poor might qualify for Affordable Care Act subsidies in states that don't expand Medicaid (8/12/13)
Report: States not expanding Medicaid stand to benefit most from doing so (7/18/13)
CMS won’t penalize hospitals in states slow to expand Medicaid (5/14/13)
Insurer Centene: We can do Arkansas-style Medicaid (5/14/13)
The Arkansas Medicaid Model: What you need to know about the 'private option' (5/2/13)
Nothing to be done about coverage gap in states not expanding Medicaid, feds say (4/29/13)
Brownback says he's listening to Medicaid expansion proponents, opponents (4/5/13)
Oregon shows costs of putting Medicaid enrollees in private coverage (3/29/13)
Governor urged to expand Medicaid eligibility (3/27/13)
Arkansas Medicaid expansion attracts other states' interest (3/26/13)
Senate president prefers options remain open on Medicaid expansion (3/25/13)
States urged to expand Medicaid with private insurance (3/22/13)
Senate budget amendment underscores opposition to Medicaid expansion (3/21/13)
Study: Kansas employers face millions a year in possible penalties without Medicaid expansion (3/15/13)
More than 30 Kansas groups pushing for Medicaid expansion (3/12/13)
Health insurers see big opportunities in health law’s Medicaid expansion (3/8/13)
Medicaid expansion supporters to step up lobbying efforts (3/7/13)
Budget committee hears resolution opposing Medicaid expansion (2/22/13)
Legislators focusing on Medicaid expansion cost estimates (2/19/13)
Kansas hospital group study predicts expanding Medicaid would generate 4,000 jobs (2/18/13)
Brownback officials release their cost projections for Medicaid expansion (2/8/13)
Medicaid expansion bill introduced (1/22/13)
Kansas hospitals worried about loss of dollars for charity care (1/14/13)
Brownback compiling own estimate of Medicaid expansion cost (12/20/12)
Group urges Brownback to expand Medicaid eligibility (11/9/12)
Debate begins on possible Kansas Medicaid expansion (10/25/12)
Amerigroup CEO says states ‘need’ to go along with Medicaid expansion (7/11/12)
Kansas hospitals ready to get on with federal health reform, spokesman says (7/2/12)
Kansas AG claims partial victory in health reform case (6/29/12)
High court upholds Affordable Care Act, but ruling puts limits on Medicaid expansion (6/28/12)

Commentary
→ Kansas Hospital Association: An opportunity for the Kansas Medicaid program
→ Americans for Prosperity-Kansas: Well-intentioned policies do more harm than good
→ Health Reform Resource Project: The cost of not expanding Medicaid
→ Rep. Jim Ward: Medicaid expansion essential for healthier Kansas
→ Rep. David Crum: Reasons for opposing Medicaid expansion
→ National Academy for State Health Policy: Much ado about Arkansas: Medicaid in the insurance exchange

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