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Wednesday, January 13, 2016

Louisiana to Expand Medicaid: Outlook for the States in 2016

Patrick Willard

Senior Director of Campaigns, Outreach, and Engagement (CORE)

Legislative sessions during an election year are historically shorter, more budget-oriented and less controversial than other years. But as the Obama administration enters its final year, the Affordable Care Act and the tools it provides for increasing health coverage are on the agenda as state lawmakers return to the capitol this month.

Medicaid expansion and its alternatives are on the table in a host of states, and coverage for immigrants and undocumented individuals is gaining traction in those states that have embraced the ACA. The political tenor of the sessions will determine whether these initiatives can advance and increase health coverage for thousands.

Louisiana becomes the newest state to expand Medicaid

At the top of the list is Louisiana, where the 2015 state elections put Medicaid expansion on the front-burner for Gov. John Bel Edwards. The nation’s newest governor was inaugurated Jan. 11, 2016, and vowed to accept the federal funds to expand Medicaid that were rejected by his predecessor, Ex-Gov. Bobby Jindal.

Edwards, a Democrat, will work with the Republican majority in the state legislature to address the state’s budget woes as he moves to expand Medicaid beginning July 1. When he signed an executive order to expand Medicaid, Edwards told reporters that the state’s voters elected him with the knowledge that he would move quickly to provide health coverage to an estimated 300,000 low-income Louisianans. 

“This is not a left versus right thing. This is right versus wrong. And today, we got on the right side,” Edwards said.

South Dakota governor endorses Medicaid expansion

Medicaid expansion continues to be on the agenda for health care advocates in the other 19 states that have not approved the option provided under the Affordable Care Act. In nearly all of those states Republicans control the legislature. Only Maine, where Democrats have a majority in the House, and Nebraska, which is officially nonpartisan, are not completely under GOP majorities. 

To date, Republican governors in 10 states support expansion. Unfortunately, the chief executives in Tennessee, Utah, and Wyoming have been unable to convince their state lawmakers to accept federal funds to cover adults with incomes below 138 percent of the federal poverty level. The election-year sessions pose a challenge for expansion efforts, but South Dakota may try to gain support for a homegrown measure.

On January 12, Gov. Dennis Daugaard of South Dakota put the issue on the table in his budget and State of the State address. Daugaard is negotiating with federal officials for expansion and urged lawmakers to support expansion if those efforts can win approval for federal funding and make improvements to the Indian Health Services program.

Other states that may to take up alternative Medicaid expansions include Alabama and Wyoming. Idaho lawmakers will consider a plan by Gov. Butch Otter that would stop short of expansion and instead create a Primary Care Access Program that would be state-funded.

Kentucky governor may roll back the state’s progress in health coverage

The Bluegrass state has been one of the nation’s success stories for the ACA, but newly-elected Gov. Matt Bevin wants to make changes. He plans to end the current state-based marketplace, and move to HealthCare.gov. But, despite his promise early on in the 2015 gubernatorial campaign to dismantle it, Bevin decided not to drop the state’s Medicaid expansion

Bevin wants to revamp the expansion plan through a waiver. State lawmakers plan to consider the expansion reforms during the legislative session. Democrats currently control the House of Representatives, but their majority has dwindled since Bevin took office, as a couple of lawmakers have defected to the Republican caucus. 

Extending health coverage to undocumented residents on the table in California and Florida

One place where advocates want to move beyond Medicaid expansion is the Golden State, as the California Endowment and Health Access California lead the campaign for #Health4All legislation. After a successful effort to increase coverage for children in 2015, a coalition of groups will push this year to ensure access to coverage for all Californians, regardless of immigration status.

Advocates are looking at the ways a 1332 waiver might be used to provide coverage for undocumented individuals to get health insurance. Other states are watching the efforts in California to see whether those who are not covered by the Affordable Care Act can find new ways to get comprehensive, affordable health care. 

Coverage for immigrant children is the goal of Florida CHAIN, which wants to remove the five-year waiting period for legally residing children who meet the requirements for the state’s CHIP program. The legislation would provide coverage for an estimated 13,400 children under KidCare.

More than 30 states opened their sessions by January 13. The remaining legislatures with 2016 sessions will convene between now and late April. Four states, Montana, Nevada, North Dakota, and Texas do not have sessions in 2016.

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