HHS to states: Partial Medicaid expansion won't get full federal funding

Dec 12 2012

On Monday, the Department of Health and Human Services said it was all or nothing on the health care law's expansion of Medicaid eligibility, disappointing some Republican governors who were considering smaller growth in the state-federal program for the poor and elderly.

Kaiser Health News: HHS Tells States It Will Not Fund Partial Medicaid Expansion
The Obama administration answered a key question from governors on Monday with a clear 'no': States may not expand Medicaid only part of the way and still get the additional federal funding provided in the Affordable Care Act. The decision, announced by Health and Human Services Secretary Kathleen Sebelius in a letter sent to governors, is significant because after the Supreme Court ruling in June made the Medicaid expansion optional, several states have floated the idea of a less generous expansion than called for in the federal health law" (Galewitz and Carey, 12/10).

Los Angeles Times: States Pressed To Guarantee Medicaid Expansion
The Obama administration stepped up pressure on states Monday to guarantee insurance for all their low-income residents in 2014 under the new healthcare law, warning governors that the federal government would not pick up the total cost of partially expanding coverage. … But Sebelius indicated that governors who do not open their Medicaid programs to all eligible low-income residents would forfeit some of the federal aid promised by the Affordable Care Act (Levey, 12/11).

The Washington Post: Partial Medicaid Expansions Won't Get Full Federal Funding, Administration Tells States
The Obama administration told states Monday that they couldn't do a partial expansion of Medicaid under the health-care law and still receive full federal funding, disappointing many Republican governors on one of the most important questions surrounding the health-care law. In recent weeks, these governors, along with other state officials, had shown increasing interest in the idea of a partial expansion of the state-federal program for the poor and disabled. In ruling that option out, the administration has raised the stakes for states debating whether to participate in a part of the law that is crucial to its success (Aizenman, 12/10).

NPR: Feds Say 'No' To Partial Medicaid Expansion
After several months of consideration, the Obama Administration delivered its decision Monday, as part of a series of questions and answers for states about Medicaid expansions and setting up health care exchanges (Rovner, 12/10).

The Associated Press/Washington Post: Feds Say States Must Follow Health Care Law To Get Full Medicaid Funding For Low-Income People
The ruling affects a federal-state program that covers nearly 60 million low-income and severely disabled people, caught in a tug-of-war between Republican governors and the Democratic administration. President Barack Obama's health care law expanded Medicaid to cover people up to 138 percent of the federal poverty line, or about $15,400 for an individual. The change mainly affects low-income adults without children at home, as well as low-income parents who can't get coverage under current Medicaid rules (12/10).

The Wall Street Journal: Feds Nix Partial Medicaid Expansion
Around half of the 30 million people expected to gain coverage from the law as it was passed were to gain it through the growth of Medicaid. … This summer, the Supreme Court's decision on the health overhaul's constitutionality effectively gave states the chance to choose whether to expand eligibility criteria for the program. Many Republican governors, and some Democratic ones, had indicated they were worried they wouldn't be able to meet their share of the costs of the full expansion. But several of those states had suggested they might be open to enrolling some residents whose incomes put them below the federal poverty level if they could exclude residents who had incomes just above the level. … On Monday, federal health officials ruled out that option and said they were confident governors would still decide to participate in the expansion as it was set out in the law (Radnofsky, 12/10).

Politico Pro: Reaction To Medicaid Expansion Policy Splits
Supporters of the massive Medicaid expansion under health reform cheered HHS's Monday announcement that states have to do all or nothing -; partial expansion isn't an option. But critics said the Republican governors may dig in more, seeing HHS offering a dagger, not an olive branch. "Rather than try to engage Republican governors, they decided to ramp up political pressure from provider groups and everyone else and make their lives miserable," said Michael Ramlet, director of health policy at the American Action Forum. "The Obama administration's refusal to grant states more flexibility on Medicaid is as disheartening as it is short-sighted," the new Republican Governors Association Chairman Bobby Jindal of Louisiana said in a statement (Norman and Cheney, 12/10).

The Associated Press: Branstad: High Medicaid Costs Complicate Expansion
Gov. Terry Branstad said Iowa's state budget is already being squeezed by health care costs, even before a federally mandated expansion of the state's program takes effect next year as part of the 2010 health care act signed by President Barack Obama. But if Branstad and other Republican governors hoped to exempt their states from that expansion, they also received that answer on Monday (12/10).

KQED California Report: Feds To States On Medicaid: Expand Fully Or No New Funding
The Obama Administration handed down a key rule Monday on its health care overhaul having to do with Medicaid, or Medi-Cal in California. States must expand to the federally mandated 138 percent of poverty in order to receive matching funds for those newly eligible for the program. Because the Supreme Court ruling in June had struck down the requirement that states participate or lose existing match funds, some states thought there might be flexibility in the expansion. But the answer to that question is a clear "no" as Secretary of Health and Human Services Kathleen Sebelius explained in a letter to governors. In a briefing last week, California's Health and Human Services Secretary Diana Dooley indicated she was waiting for guidance from the feds about the Medicaid expansion and might not expand to the full 138 percent limit (Aliferis, 12/10).

The Arizona Republic: Arizona AHCCCS Funding Could Stagnate
States will not receive more-generous funding to expand their Medicaid programs unless they agree to the fullest extent intended under federal health-care reform, the U.S. health secretary warned Monday. Partial expansion of Medicaid, as Gov. Jan Brewer and other governors have been considering, would bring no additional federal benefit beyond the traditional share already paid to states, Health and Human Services Secretary Kathleen Sebelius announced in a letter to governors (Reinhart, 12/10).

Medpage Today: No $ For Partial Medicaid Expansion
States must cover all adults with incomes up to 133 percent of the federal poverty level in order to have the federal government pay for their expanded Medicaid program, the government said Monday. While states can choose to set their coverage limits at less than 133 percent, if they do so, the federal government won't pay for 100 percent of the cost for those newly eligible enrollees as stipulated by the Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services (CMS) announced. "Consistent with the law, there is not an option for enhanced match for a partial or phased-in Medicaid expansion," acting CMS administrator Marilyn Tavenner told reporters on a call (Pittman, 12/10).