A look ahead at Medicaid expansion

When it comes to Medicaid expansion, states have some room to get creative.

Arkansas, Iowa, Michigan and Pennsylvania, for instance, have received approval through Section 115 waivers to expand Medicaid in their own ways. Indiana became the most recent state to receive an approved-waiver. In these states, the expansion rules do not necessarily meet federal rules.

"There are a lot of flexibilities within the healthcare reform law," Robin Rudowitz, associate director of the Kaiser Commission on Medicaid and the Uninsured, said on a call with reporters Wednesday. "The waiver program was designed with the intention to allow states to test out Medicaid options. It's up to them now."

The call was hosted by the Kaiser Family Foundation and discussed key issues around Medicaid expansion efforts in the states. FierceHealthPayer sat in on the call.

While states that choose to submit waivers have some wiggle room, the Centers for Medicare & Medicaid Services (CMS) issued guidance that prohibits waivers to impose enrollment caps or implement partial expansion, Rudowitz mentioned. What's more, CMS has denied proposals to impose premiums as a condition of eligibility for beneficiaries below the federal poverty level.

States that expanded Medicaid already are experiencing positive results. The 29 states, including the District of Columbia, which chose to expand experienced an increase of 18 percent in enrollment growth in fiscal year 2015, compared to 5.2 percent growth in non-expansion states. Low-income workers and adults without children have benefitted most from Medicaid expansion, FierceHealthPayer previously reported.

Additionally, those 28 states and D.C. reduced the number of uninsured residents, increased state savings both within Medicaid and outside the program and increased economic activity, said Laura Snyder, senior policy analyst at KFF.

As 2015 rolls on, what's up in the air is what the remaining states will do regarding expansion.

"Expansion is still under debate in many states," Rudowitz mentioned. These states include Montana, Utah and Wyoming. Others states show no signs of expansion; in particular, Texas and Florida remain wary to expand Medicaid, even though an estimated 1 milion residents of each state could gain coverage. 

"Many were opposed based on ideological grounds--against Medicaid and the Affordable Care Act," Rudowitz said. "States are concerned about costs, and about the federal government's commitment to maintain the 90 percent match rate."

Ultimately, states looking to expand the program share the same goal: Providing health coverage to low-income residents, whether it's exactly as the ACA intended or a little bit different.