Governors grapple with Medicaid uncertainty

With the Supreme Court ruling that much of the Patient Protection and Affordable Care Act is constitutional, the National Governors Association (NGA) and National Association of Medicaid Directors (NAMD) are asking the U.S. Department of Health & Human Services to clarify the Medicaid expansion provision, reported AHA News Now.

A key provision under health reform gives states the option to take advantage of or forgo expanding the federal state program. However, both groups have a list of questions that need answers before they can make any Medicaid decisions.

For example, the NGA wants to know if states can phase-in Medicaid coverage up to 133 percent of the poverty line after 2014 and still get enhanced federal funds, according to a letter sent July 2 to HHS Secretary Kathleen Sebelius.

"What options and federal assistance are available for states that decide not to pursue Medicaid expansion as written in the ACA?," asked the NGA, which said clear guidance from HHS would help states determine what's best for them.

Meanwhile, the NAMD wants the Centers for Medicare & Medicaid Services to define "newly eligible" individuals for states that already have expanded some form of Medicaid to the optional adult population prior to ACA implementation.

"Will these states qualify for the full increase in enhanced federal funding? Will they qualify for expansion state funding?" the NAMD, which represents state Medicaid agencies, asked in a July 3 letter.

Providers also are grappling with challenges surrounding Medicaid expansion. ACA's Medicaid provision has left many questions unanswered for practice-based physicians. Because states are not under a deadline for opting out, physicians will have to wait to learn whether they'll need to plan for the 17 million low-income and disabled patients expected to join Medicaid's ranks, FiercePracticeManagement previously reported.

Similarly, hospitals could be stuck with the poorest patients and with the unpaid bill if states choose not to expand the program, while hospitals in states that plan to participate will have their own financial burdens from the larger volume of Medicaid patients they expect to treat.

To learn more:
- read the AHA News Now news brief
- read the NGA letter
- here is the NAMD letter (.pdf)

Suggested Articles

CMS Administrator Seema Verma pushed back on hospitals' resistance to publishing payer-negotiated prices, as now mandated by a federal rule.

New survey insights reveal how health plans can partner with providers in the path toward achieving value-based care success.

As alarms proliferate, hospitals are working to sort through the cacophony that can overwhelm staff and cause them to overlook real signs of harm.