Demonstration waivers, which at one time tinkered around the edges of the Medicaid program, are now a significant piece of the program's expansion as part of the Affordable Care Act, StateLine reported.
The Obama Administration granted significant waivers to both Arkansas and Iowa to use federal dollars to purchase private insurance for Medicaid-eligible individuals, according to the news service. Michigan has its own waiver pending, while policymakers in Pennsylvania, New Hampshire and Virginia are likely to also apply for waivers in order to expand coverage.
"The waiver process is cumbersome, and it is difficult and it is time-consuming," Vern Smith, former director of Michigan's Medicaid program, told Stateline.
However, the use of the waivers acts as a compromise, allowing enough free-market experimentation to make Medicaid expansion palatable to Republican leaders in the state, while providing renumeration to hospitals that otherwise would receive nothing for treating thousands of low-income patients.
And, according to Stateline, the U.S. Department of Health and Human Services makes some accommodations to streamline the application process.
"We have found this new level of standardization very helpful in understanding what documents and procedures a state needs to develop and complete, and the expected timeframes," said Jennifer Vermeer, who directs Iowa's Medicaid program.
The use of waivers means a slim majority of states have so far agreed to expand Medicaid income eligibility as part of the ACA. Altogether, 26 states have agreed to expand Medicaid, while only 22 appear to be steadfast against expansion.
However, the Arkansas waiver could be in danger of elimination once the state Legislature reconvenes later this year.
The loss of a key Democratic lawmaker in a recent special election means there are enough Republican votes to repeal participation in Medicaid expansion, even though it would require a 75 percent supermajority to do so and overcome a veto threat from Gov. Mike Beebe, the Washington Post reported.