How Far Will Obama Administration Bend for Medicaid Expansion in Republican States?

First published on MedCityNews.com.

First published on MedCityNews.com. When Pennsylvania got the Obama administration’s signoff on its Medicaid expansion plans last week, it became the ninth state with a Republican governor to agree to broaden coverage for low-income residents – a key component of Obama’s healthcare reform law.

Getting to that point, though, wasn’t easy. The Obama administration has made itself open to negotiations with red state governors who say they would support Medicaid expansion with some tweaks to how it was originally proposed.

Pennsylvania, for example, was allowed to charge premiums to enrollees above the poverty level, as well as charge $8 copays for members who visit the emergency room for non-emergency situations.

But not everything is fair game for compromise. Sarah Kliff highlighted the administration’s stance on what is and isn’t up for negotiation as states like Tennessee, Utah and Virginia explore the possibility of expanding Medicaid.

ACCEPTED

• Iowa, too, can charge premiums to some higher earning enrollees, although they have opportunities to reduce those premiums.

• Plans approved in Arkansas and Iowa enroll those who qualify for expanded Medicaid into the same private health plans offered on the exchange, using federal dollars to pay their premiums.

• The federal government relieved Medicaid plan providers in Iowa of covering transportation for non-emergency care.

• Michigan and Iowa offer lower premiums and cost sharing to enrollees who undergo an annual health assessments and commit to improving their health.

REJECTED

• Pennsylvania Gov. Tom Corbett proposed requiring people to be employed or seeking employment to qualify for Medicaid. This was not part of the approved plan.

• Iowa originally wanted to charge a small premium to everyone who earned more than 50 percent of the federal poverty line.

STILL TBD

• Indiana Gov. Mike Pence wants to expand the state’s Healthy Indiana program, which includes health savings accounts, as an alternative to Medicaid expansion. The feds asked Gov. Pence last month to resubmit his proposal after consulting with a band of Potawatomi Indians.

[Image credit: Stuart Miles]