National News
Ricardo Alonso-Zaldivar
Associated Press
WASHINGTON (AP) — From
California
to
Rhode
Island, states are confronting new
concerns that their Medicaid costs
will rise as a result of the federal
health care law.
That’s likely to revive the debate
about how federal decisions can
saddle states with unanticipated
expenses.
Before
President
Barack
Obama’s law expanded Medicaid
eligibility, millions of people who
were already entitled to its safety-
net coverage were not enrolled.
Those same people are now sign-
ing up in unexpectedly high
numbers, partly because of public-
ity about getting insured under the
law.
For states red or blue, the catch
is that they must use more of their
own money to cover this particular
group.
In California, Democratic Gov.
Jerry Brown’s recent budget pro-
jected an additional $1.2 billion
success.”
Online exchanges that offer sub-
sidized private insurance are just
one part of the health care law’s
push to expand coverage. The
other part is Medicaid, and it has
two components.
First, the law allows states to
expand Medicaid eligibility to
people with incomes up to 138
percent of the federal poverty line,
about $16,100 for an individual.
Washington pays the entire cost
for that group through 2016, grad-
ually phasing down to a 90 percent
share. About half the states have
accepted the offer to expand cov-
erage in this way.
But whether or not a state
expands Medicaid, all states are
on the hook for a significantly big-
ger share of costs when it comes to
people who were Medicaid-eligi-
ble under previous law. The
federal government’s share for this
group averages about 60 percent
nationally. In California, it’s about
a 50-50 split, so for each previous-
ly eligible resident who signs up,
the state has to pony up half the
‘It’s not a bad thing that we are
opening a door that should have
been open before’
spending
on
Medi-Cal,
the state’s version of Medicaid,
due in part to surging numbers.
State officials say about 300,000
more already-eligible Californians
are expected to enroll than was
estimated last fall.
“Our policy goal is to get people
covered, so in that sense it’s a suc-
cess,” said state legislator Richard
Pan, a Democrat who heads the
California State Assembly’s health
committee. “We are going to have
to deal with how to support the
cost.
There could be many reasons
why people didn’t sign up in the
past.
They may have simply been
unaware. Some may not have
needed coverage. Others see a
social stigma attached to the pro-
gram for those with the lowest
incomes. But now virtually every-
one in the country is required to
have coverage or risk fines. That’s
more motivation to come forward.
“It’s not a bad thing that we are
Information is
Today’s Currency
PHOTO COURTESY OF AIDS FOUNDATION OF CHICAGO
Medicaid Surge Triggers Cost Concerns for States
opening a door that should have
been open before,” said Judy
Solomon of the Center for Budget
and Policy Priorities, which advo-
cates for the poor.
The budget consequences are
real.
“Clearly we are going to need to
do our best to make sure we are
working within the budget we are
given,” said Deidre Gifford,
Rhode Island’s Medicaid director.
States always expected that
some previously eligible people
would sign up, but Gifford said
her state enrolled 5,000 to 6,000
more than it had projected.
In Washington state, people who
were previously eligible represent
about one-third of new Medicaid
enrollments, roughly 165,00 out of
a total of nearly 483,000.
But state officials say they are
treating that as a preliminary num-
ber, and the true net increase may
be lower once they factor in peo-
ple who drop out of the program
for a host of reasons, such as get-
ting a job with coverage.
Governors in California, Rhode
Island, and Washington all strong-
ly supported the health care law.
Their outreach campaigns to pro-
mote sign-ups overall probably
contributed to drawing out unin-
sured residents who already were
entitled to Medicaid.
But researchers also are seeing
increased Medicaid enrollment
in states that have resisted the
health care law.
A recent report from the market
research firm Avalere Health
found
Georgia
enrollment
increased by nearly 6 percent.
Montana saw a 10 percent rise and
South Carolina 5 percent. A big
exception is Texas, which has
barely seen any increase.
“Anyone who didn’t budget for
this is going to be behind the eight
ball,” said Avalere CEO Dan
Mendelson. “It’s the kind of thing
governors will want to discuss
with the White House.”
When the health care law was
being debated in Congress, many
states recognized they might face
a problem if droves of already-eli-
gible people joined Medicaid.
States lobbied federal lawmakers
— unsuccessfully — to get more
money for that group, said Ray
Scheppach, the former top staffer
for the National Governors Asso-
ciation.
“States are concerned about
this,” he said. “It’s something they
had been worried about right
along.”
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