Some proposals would allow states to move current Medicaid enrollees to the public plan and some would require states to contribute to the costs through an MOE. Under some Medicare-for-all proposals, the federal government assumes all or a significant share state spending on Medicaid, leading to significant state savings, while other proposals call for a maintenance of effort for all or some current state Medicaid spending. A constitutional ballot typically requires more work and stronger support. How much of a role will Medicaid play in state races, particularly in non-expansion states? Not all states allow ballot initiatives. The Maine campaign succeeded, with 59% of voters supporting Medicaid expansion. But in June 2020, voters in Oklahoma passed a Medicaid expansion ballot initiative, paving the way for Medicaid expansion to take effect in Oklahoma by July 2021. CMS program integrity efforts including audits, heightened oversight of state claiming for enhanced federal matching funds for the ACA expansion and a new proposed rule related to supplemental payments and other state financing practices could have broader implications for Medicaid that could reduce federal spending in the program. Parson, who opposes Medicaid expansion and is up for election this year, in May moved the vote on the proposal up from the Nov. 3 general election to Tuesday's primary. In addition, litigation challenging the ACA with support from the Trump administration is ongoing, with continued uncertainty about the law’s future. Missouri approves Medicaid expansion ballot initiative, extending coverage to 200,000 people Dylan Scott 8/5/2020 Federal Judge Blocks Texas Gov. While slower enrollment has moderated spending growth, rising costs for prescription drugs, provider rate increases, and costs for the elderly and people with disabilities (including increased utilization of long-term services and supports) are expected to put upward pressure on total Medicaid spending. In Oklahoma, for example, ballot organizers can pursue statutory or constitutional initiatives. All Democratic presidential candidates differ sharply from policies advanced by the Trump Administration related to the ACA and Medicaid more broadly. At the state level, there are 11 governors up for election in 2020 (four seats currently held by Democrats (DE, NC, MY and WA) and seven seats held by Republicans (MO, ND, NH, IN, UT, VT and WV)). Opens in a new window. How will states and the federal government develop capacity and meet workforce and housing challenges to meet the needs of the growing elderly population? As ACA funds and other disaster funds were set to expire Congress authorized additional funding of $5.7 billion for FY 2020 and FY 2021 (including $5.3 billion for Puerto Rico). How will changes in the economy and the continued aging population affect Medicaid spending and enrollment trends in the future? Merrill’s group quickly gathered enough signatures to secure a spot on the 2017 ballot. Without the waivers, states have limited authority to finance these services for nonelderly adults in IMDs. His group represents 95,000 hospital workers in California. How will other CMS policy changes related to increased oversight, audits and policy changes affect Medicaid spending and enrollment? Some states are seeking waiver authority to implement a new expansion or make changes to an existing expansion. As the need for Medicaid long-term services and supports is expected to rise as the population continues to age, states continue to expand the number of people served in home and community-based settings; however, direct care workforce and affordable housing shortages remain challenges in meeting the demands to serve the elderly and people with disabilities in community settings. Elizabeth Hinton, sltrib.com © 1996-2020 The Salt Lake Tribune. The latest example was in Missouri, which this summer expanded Medicaid via a voter initiative. Utah’s government added a provision that Medicaid enrollees had to work, volunteer or search for work to secure coverage, a restriction not in the original ballot. In addition, North Carolina came close to passing the Medicaid expansion through the state legislature during the 2019 session, but ultimately failed to do so, adjourning the session without a budget. At the start of 2020, 37 states had adopted the ACA Medicaid expansion. What strategies will be successful in stemming cost increases for Medicaid prescription drugs while maintaining access to new medications? Some Democratic presidential candidates support a Medicare-for-All option while others propose or endorse a “public option”. After Nebraska voters approved a Medicaid expansion ballot measure in November 2018, the state delayed implementation until October 1, 2020 to allow time for the state to seek a Section 1115 waiver to implement expansion. This qualified the initiative for the November ballot unless the governor called for it to go on the August ballot by the May 26 deadline. While there are differences across all of the proposals and many lack sufficient details to fully understand the effects, these plans all could fundamentally change the broader health care system and would have significant implications for Medicaid and the role of states, an issue that has not received much attention. Will CMS issue guidance about block grant waivers and will the pending Tennessee waiver be approved? On December 18, 2019, the 5th Circuit decided in Texas v. Azar to send the case back to the trial court for additional analysis on whether the individual mandate can be severed from the rest of the ACA, to determine if the entire ACA is struck down or not. A review of over 300 studies points to positive effects of expansion on coverage, access to care, service utilization, and state budgets and economies. “It felt like this was a huge problem that many wanted to fix, and that we had to find a way to make it happen.”. It also added a work requirement, although both it and, Utah have suspended those rules during the pandemic. “Ballots are an opportunity to put a question, in its undiluted form, in front of millions of people,” he said. The Missouri Medicaid Expansion and Planned Parenthood Funding Initiative was on the ballot in Missouri as an initiated state statute on November 3, 2020. Some states have more unique models, including a modified subscription model for hepatitis C drugs in Louisiana. Of the 12 remaining states that have not expanded Medicaid (excluding Missouri, where voters will decide Tuesday), only four have referendum processes: Florida, Mississippi, South Dakota and Wyoming. Future Medicaid enrollment and spending trends will likely be affected by an inevitable economic downturn as well as the aging population. Samantha Artiga Follow @SArtiga2 on Twitter For 2020, this was an annual income of $17,600 for an individual and roughly $36,000 for a family of four. Although lawmakers in Utah and Idaho passed legislation in 2019 to adjust the terms of the Medicaid expansion ballot initiatives that voters had passed in those states, Nebraska lawmakers did not (and they did include funding for the stateâs share of the cost of the first nine months of Medicaid expansion in the budgetthat was signed by Ricketts in May 2019). Other states with approval have not yet implemented (Ohio, South Carolina, Utah, and Wisconsin) or have put the program on hold due to pending litigation (Arizona and Indiana). Expansion activityis ongoing in a nâ¦ Published: Jan 17, 2020. Millions of adults could gain Medicaid eligibility if additional states expanded their programs. The focus of Section 1115 waivers has changed over time reflecting changing priorities for states and CMS. Managed care continues to be the dominant delivery system for Medicaid. Health advocates in Missouri have launched an effort to put Medicaid expansion on the ballot in 2020. , Once again, health care is a key issue for voters heading into the 2020 elections. Beyond work requirements, CMS has issued guidance and has been approving waivers to allow states to use Medicaid funds to provide short-term inpatient and residential treatment for enrollees with substance use disorder (SUD) and enrollees with serious mental illness (SMI) or serious emotional disturbance (SED) in institutions “institutions for mental disease” (IMDs). Existing authority to help states provide care in the community including spousal impoverishment rules and the Money Follows the Person program were set to expire at the end of 2019 but received an extension through May 2020. “We were left with either doing nothing or finding a new solution. , and The petition to put a Medicaid expansion in Missouri to a statewide vote has garnered more than 25 percent of the needed signatures to place the measure on the November 2020 ballotâ¦ In the meantime, a group of 21 states represented by Democratic state officials and led by California, and the Democratic-led House of Representatives has asked the Supreme Court for an expedited review of the case, which could result in a final decision before the 2020 election. The Maine legislature had already passed bills to expand Medicaid five times, only to have each vetoed by Gov. Instead, the Nebraska-specific modifications to Medicaid expansion have come from Governor Rickettsâ administration. Will additional states move to adopt the Medicaid expansion in 2020? All rights reserved. Florida, which has 2.7 million uninsured residents, is the Fairness Project’s next major focus. Nebraska began enrolling patients into its Medicaid expansion only this month, nearly two years after the ballot passed. How will states continue to leverage Medicaid to address key issues like maternal mortality, the opioid epidemic and other social determinants of health? LePage of Maine said he “would go to jail” before expanding Medicaid. The campaign for â¦ In recent years, enrollment growth has slowed or declined in many states and declined nationally by 1.9 million from December 2017 through July 2019 as unemployment has reached historically low levels and the number of people in poverty has declined. CMS has been developing guidance and will consider a waiver from Tennessee seeking a modified block grant with shared savings provisions. The proposals would extend coverage for certain Medicaid services such as comprehensive benefits for children and community based long-term care. “But we still need to give regular people the opportunity to have positive change in their lives.”. The waiver proposal also contains other provisions that would restrict eligibility and benefits. That caught the attention of supporters in other states, who were similarly struggling to enact the program. States run by Democrats eagerly signed up for the program, lured in part by generous federal funding. Contact Senior Director of Policy Erin OâMalley at firstname.lastname@example.org or 202.585.0127 with questions. This total includes Idaho and Utah, which implemented the expansion on January 1, 2020, and Nebraska, where the expansion was adopted but not yet implemented. Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff. We need the grassroots infrastructure, and we need to disrupt the messaging and all that has been invested in attacking this policy.”, Donate to the newsroom now. How will the courts rule in the appeal of the Arkansas waiver related to work requirements and what will that mean for other states? The ballot initiative, which began long before the coronavirus pandemic but took on increased urgency amid the outbreak, passed narrowly with a majority of 50.5%, a margin of about 1 percentage point. Oklahoma and Missouri joined four other states in passing Medicaid expansion via ballot initiatives. Nebraska's voters approved Medicaid expansion via Initiative 427. “Some of us were a little skeptical at first,” said Jennings, who has since become an informal adviser to the Fairness Project. U.S. Coronavirus Cases (12/03): 14.140 million, Without the waivers, states have limited authority to finance these services for nonelderly adults in IMDs, reduced funds to support outreach and enrollment assistance, initiatives to improve birth outcomes and/or reduce maternal mortality. The Trump Administration has proposed to significantly limit federal Medicaid funds, convert Medicaid to a block grant, and repeal the ACA (which would end the authority for the Medicaid expansion and other Medicaid provisions); these policies are not supported by any Democratic candidate. The next year, it returned to Maine to support the country’s first Medicaid expansion referendum. Missouri will vote on a Medicaid ballot initiative Tuesday. It is the sixth state â¦ “As opposed to traditional legislative work, where things get watered down to get out of committee, you end up with what you actually want when you use the ballot.”. Georgia submitted a waiver to the Centers for Medicare and Medicaid Services (CMS) seeking approval for a Medicaid expansion with enhanced ACA funding with coverage up to 100% of the federal poverty level (FPL) for individuals who meet work requirements. Medicaid expansion initiative approved by voters; expansion will take effect by July 2021. Expansion activity is ongoing in a number of states that have not adopted the expansion. Medicaid spending and enrollment trends not only reflect policy changes at the state and federal level but also reflect changes in the economy as well as demographic changes. “You need a substantial campaign entity, especially in Florida where every region is like its own state. But they’re taking on hard issues in hard states, and they’re a lot more successful than some of us can say.”. In Ballot measures May 27, 2020 at 2:51 PM On May 22, 2020, the Missouri Secretary of State issued a statement certifying the Missouri Medicaid Expansion Initiative for the ballot. Current status for â¦ Share on Facebook. “People were frustrated,” said Chris Jennings, a longtime health care strategist who served in the Clinton and Obama administrations. Some states continue to seek approval for similar waivers. But the initiative had enough support that the United Healthcare Workers West executive board approved its funding, and has continued to do so each year since. Such post-ballot resistance prompted the Fairness Project to revise its strategy for its 2020 Medicaid campaign in Oklahoma. Status of State Medicaid Expansion Decisions: Interactive Map, Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State, A View from the States: Key Medicaid Policy Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2019 and 2020. Over the last decade, Medicaid spending and enrollment peaked during the Great Recession (when incomes fell and more people qualified and enrolled in Medicaid and other public programs) and then again with implementation of the Affordable Care Act (ACA). Mike Parson, a Republican, opposes the ballot initiative and has argued that it will harm a state budget that is already under strain because of the pandemic. After the initiatives pass, governors often delay, alter or outright refuse implementation. And while the modifications are not as drâ¦ Other factors contributing to enrollment declines may be reduced funds to support outreach and enrollment assistance as well as the shifting immigration policy environment that may be deterring some families from enrolling themselves or their children in coverage or continuing coverage at renewal, despite being eligible. The Fairness Project joined the campaign shortly afterward, providing financial support for advertising and data about which voters to target and how to reach them. A proposal to amend the state Constitution to expand eligibility for Medicaid is on Tuesday, Aug. 4, 2020s' ballot. In many state capitals, hospitals have led the fight for Medicaid expansion either by lobbying lawmakers or bankrolling ballot initiatives. , Two weeks ago, Oklahomans went to the polls and voted in favor of State Question 802, a ballot initiative to expand Medicaid. However, the short extension and new disasters like the earthquakes in Puerto Rico mean that long-term funding is not secure and new health care needs will emerge. From 2014 through 2016, the ACAâs Medicaid expansion population was funded 100% with federal dollars. In some cases, reduced federal spending may be tied to additional oversight to ensure states are complying with current rules, while in other cases the reductions may reflect CMS changes or proposed changes in policies.
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