KHI News Service

Sebelius: Feds flexible on how states expand Medicaid

HHS secretary spoke at two KC events

By Mike Sherry | September 22, 2013

The federal government welcomes state experimentation when it comes to the Medicaid expansion encouraged under the health-reform law, U.S. Health and Human Services Secretary Kathleen Sebelius said Saturday.

“I do believe in the phrase that the laboratories of democracy are state government. The opportunity to innovate, the opportunity to share good notions,” Sebelius said, speaking to about 500 state officials at the national conference of the Council of State Governments. “But I think also the federal government can play a key role in helping you acquire the beakers, mixers and test tubes that allow your states to produce better results, and we stand ready as a partner.

“We have done a lot of work in my time as secretary with various states to see Medicaid differently, depending on where they are in the country. We are open to a very flexible example. We want to see what states have in mind,” Sebelius said.

She cited examples of states that are expanding Medicaid using a private insurance model for higher-income Medicaid recipients and others that are incorporating wellness strategies into their programs.

Under the Affordable Care Act, the federal government has offered to pay 100 percent of the expansion cost to states that increase Medicaid eligibility to 138 percent of the poverty level for the first three years. After that, the federal government would cover 90 percent o the cost, leaving the other 10 percent to the states. Currently, states pay about 40 percent.

Neither Kansas nor Missouri has expanded Medicaid through the ACA. Kansas, however, has won federal approval to move its Medicaid population into a managed care system called KanCare, an initiative that began Jan. 1.

Sebelius is a former elected official from Kansas, including terms as governor and insurance commissioner.

The executive director of the Council of State Governments is David Adkins, a former Republican state lawmaker in Kansas. He served with Sebelius in the Legislature.

Sebelius’ speech Saturday was part of a two-day visit here where she discussed health-reform with a variety of audiences. After appearing at the state government conference, she spoke at the opening of an all-day conference here on mental health issues.

On Friday, she met with various community representatives to discuss implementation of the new health insurance marketplaces created under the health-reform law. Open enrollment for the marketplaces begins Oct. 1.

In speaking to the state officials, she repeated her argument that the time for political debate about the health reform law is past.

“It’s the law,” she said, “and it will be as long as President Obama is in office.”

Mental health forum

The mental health conference was one of several taking place across the country, at the behest of the Obama administration, following the school shooting in Connecticut last year. The conference drew about 300 people, including consumers and mental health workers.

The Kansas City conference also came just days after a fatal shooting at a military installation in Washington, D.C.

“The shooting in the Navy Yard has once again galvanized some national attention” on what can happen in instances of untreated mental illness, Sebelius said.

She said that 60 percent of all Americans who have mental health conditions and 90 percent of Americans with substance abuse disorder do not get the treatment they need.

“We would never let that happen if (that involved) 60 percent of people identified with cancer or who had heart attacks or who had an open wound — we would not let that happen in this country,” she said.

The Affordable Care Act mandates an essential benefit package for health insurance policies, which includes coverage for mental health and substance abuse.

But, Sebelius said, new laws can only change so much.

“We have to change hearts and minds,” she said. “We have to break down the social barriers” that lead people to hide their mental health problems.

Sebelius said she had experienced the mental health system first hand during the past six months, when two members of her family experienced crises. She said that experience led her to sympathize with people who have to navigate the system every day.

Solutions come at the local level through conversations like the one here, she said.

“Your willingness to have this conversation is huge,” she said.

Sebelius’s appearance was an important boost for the Kansas City event, said Carolyn Lukensmeyer, executive director of the National Institute for Civil Discourse, which is heading up the steering committee coordinating the national mental health dialogue.

“She made it clear she was listening,” she 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)

→ 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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