09 Nov 2018 Medicaid expansion: coming to a state near you
Among all the talk of waves and tides of the close midterm races around the country, there were tremendous results on Tuesday night for Medicaid expansion. Three states – Idaho, Nebraska, and Utah – passed ballot initiatives approving the policy.
On top of that, in Kansas and Maine, Governors who had vetoed the policy in the past were replaced with candidates promising to enact it.
This was obviously great news for supporters of Medicaid expansion with the total number of expansion states firmly at 36.
What were the issues?
In Idaho, the Expansion ballot initiative was designed to provide insurance covers for individuals under the age of sixty-five and whose income is below 138 percent of the federal poverty level and who are not eligible for any other state insurance cover.
Among the proponents of Medicaid in Idaho was State representative Christy Perry a Republican and staunch Trump supporter. She had over the years attempted to push for the expansion through the state legislature but faced resistance from statehouse leaders.
The scenario in Idaho applies to Utah and Nebraska, with the ballot initiative being necessitated by the strong opposition from the majority of Republicans and statehouse leaders. In Utah, opponents of the Expansion argued that the initiative would bankrupt the state treasury. In Nebraska caution was given against reliance on federal government financing for state programs noting that often the national government scale back or neglect supporting state programs without proper transitional mechanisms.
However, it was difficult to debate against the fact that Medicaid would free up resources invested by the state governments in local insurance programs and that the federal government is legally obliged to pay 90% of the cost of the policy.
So, what does this mean?
The successes of the ballot initiatives mean an additional 300,000 plus Americans including 62,000 people in Idaho, 90,000 and 150,000 people in Nebraska and Utah respectively get access to insurance coverage.
In addition to this being a win for the states, and the people, it is also a big win for insurers. Already, the pattern is set, with more states moving away from the fee-for-service arrangements to the Managed Care Model. The shift is necessary because state planning and budgeting under the previous arrangement was impossible as costs were not predictable and only became apparent after the service.
Under the Managed Care Model, Medicaid agencies contract managed care organizations (MCOs) to accept a capitation payment (set per member per month) for their services. This means that the costs are controlled, but caution is required to ensure that payment is not inadvertently placed ahead of health outcomes to the detriment of consumers.
Most importantly, the change means an immense opportunity for the states involved. All five states now have the chance to redesign their Medicaid programs as they work out the necessary details. States are usually reluctant to make disruptive changes to essential programs, but this can mean missing out on innovation. With a redesign required already to expand the program, states can take a big-picture look at ways to improve.
One area that could use improvement in many states is their provider registries. The registries are often clunky, difficult to use, and full of old information. It’s already difficult for Medicaid recipients to find providers accepting their insurance, especially in rural areas. Outdated information makes it harder. More connected health technology makes it possible for states to address this more easily. Medicaid expansion gives an excellent opportunity to do so.
What differences will people see immediately?
Another area that should be addressed soon is eligibility. Medicaid programs are always complicated, and it can be hard for people to know whether they qualify for benefits – and if so, which ones. Some states have started using interactive, easy-to-use guides online. The guides inform applicants what they will likely qualify for, and tell enrollees what benefits they get. Stress and confusion are avoided, and recipients are more likely to use their coverage, meaning better outcomes in the long-term.
Finally, states also have the chance to embrace new methods of care delivery. The massive growth in telehealth in the past decade has outpaced what states can keep up with. Now, a considerable amount of routing, diagnostic, and even restorative care can be done remotely. This saves patients time and money, improves access, and means providers can use their time more efficiently.
These new methods of delivery take time and effort to implement. Still, introducing Medicaid is disruptive but positive overall, and makes the perfect opportunity for states to embrace new ways of care that produce better outcomes at less expense.