Policy Analysis | February 2015

February 2015: The Status of Medicaid Expansion in the SLC States

Lauren Greer

ALABAMA Governor Robert Bentley (R) indicated in December 2014 that he was open to the possibility of Medicaid expansion in the form of a state-designed program that uses private sector insurance and imposes work and job training requirements on the recipients. Governor Bentley has signaled that he may ask the federal government for a block grant to accomplish this expansion. Since the governor’s re-positioning, legislative leaders in Alabama have been relatively quiet on the idea, but Senate President Pro Tem Del Marsh (R) has said he does not think the issue would gain much traction in the Legislature. Support or opposition for the governor’s proposal may become more pronounced in the coming weeks, as legislators get ready to convene the legislative session on March 3, 2015.

ARKANSAS Arkansas has reauthorized funding for its private option alternative to Medicaid expansion through FY 2016. Under additional legislation passed during the 2015 session, the private option expansion will terminate on December 31, 2016, and a newly created legislative task force will make recommendations on alternative coverage models. According to the Arkansas Department of Human Services, as of November 30, 2014, 188,023 individuals have enrolled through the private option program, with an additional 25,117 medically frail individuals enrolled in traditional Medicaid.

FLORIDA Governor Rick Scott (R) initially announced his support of expansion in 2013, but legislative efforts to create the “Healthy Florida” program fell short with opposition from former Speaker Will Weatherford (R). With the 2015 legislative session set to begin on March 3, a coalition of business leaders and groups from the health industry are proposing the “Healthy Florida Works” plan, which would require participants to pay some premiums and participate in health and job training programs. Incoming Speaker Steve Crisafulli (R) has not shut the door completely on Medicaid expansion, but he remains skeptical about the proposition. The Florida Senate has been more receptive to considering the idea of Medicaid expansion, with Senate President Andy Gardiner (R) calling the Healthy Florida Works proposal “intriguing.”

GEORGIA In 2014, with the support of Governor Nathan Deal (R), Georgia passed two pieces of legislation codifying its opposition to Medicaid expansion. HB 990 removed possible authority to expand Medicaid from all other entities by requiring legislative approval prior to taking such action. HB 943 prohibits the state or any of its units or political subdivisions from using money, human resources, or assets to advocate or intend to influence the citizens of the state to support the voluntary expansion of eligibility for medical assistance in furtherance of the ACA.

KENTUCKY With support from Governor Steve Beshear (D), Kentucky began operating a fully expanded Medicaid program on January 1, 2014. The state implemented a standard expansion and did not seek waivers for alternate models. According to pre-expansion estimates, roughly 300,000 Kentuckians would be eligible for coverage under the expanded programs. The most recent data from the Center for Medicare and Medicaid Services (CMS) estimates that as of March 2014, 247,899 individuals were Medicaid expansion enrollees, which represents 23 percent of total Medicaid enrollees at the time.

LOUISIANA Governor Bobby Jindal (R) opposes Medicaid expansion and the state is not expected to take any action to implement any form of expansion.

MISSISSIPPI Governor Phil Bryant(R) opposes Medicaid expansion. In 2014, the House defeated an amendment tying state appropriations to the expansion of Medicaid. In 2015, several pieces of legislation supporting the expansion were not brought for a vote in committee.

MISSOURI During his 2014 and 2015 State of the State addresses, Governor Jay Nixon (D) urged legislators to support Medicaid expansion and included expansion as part of his FY2016 budget proposals. Leaders in the House (R) and Senate (R) have said Medicaid expansion is not up for discussion during the 2015 session, with some senators vowing to filibuster any such discussion if it does come up.

NORTH CAROLINA In recent months, Governor Pat McCroy (R) has indicated that he is open to considering alternative forms of Medicaid expansion, especially those with job or job-training requirements for eligibility. In 2013, McCroy signed legislation to require approval from the General Assembly before expanding Medicaid. Speaker Tim Moore (R) and Senate President Pro Tem Phil Berger (R) both have said they oppose expanding the state’s Medicaid program.

OKLAHOMA Governor Mary Fallin (R) opposes Medicaid expansion, making specific reference to the proposition in her 2014 State of the State address. Given that House Speaker Jeff Hickman (R) and Senate President Pro Tem Brian Bingman (R) also oppose expansion, it likely will not be an issue during the 2015 legislative session.

SOUTH CAROLINA Governor Nikki Haley (R) opposes Medicaid expansion and it is not expected to be part of the discussion by the General Assembly during the 2015 legislative session.

TENNESSEE Governor Bill Haslam (R) called for a special session in early February 2015 for the purpose of considering the Insure Tennessee expansion plan. During the brief special session, the proposal was voted down by a vote of 7-4 in the Senate Health and Welfare Committee on February 5, 2015, effectively ending discussions before the proposal was brought to a vote in either chamber. Governor Haslam is not expected to reintroduce the issue during the state’s regular session, which began the following week, on Monday, February 9, 2015. Had the Tennessee General Assembly approved the plan, the state would still have to submit its proposal to CMS for official approval of the waiver amendment.

TEXAS Newly elected Governor Greg Abbott (R) has said that he does not support the Medicaid expansion. However, the governor has shown some interest in the state drawing down Medicaid dollars through block grants. In late 2014, the 15-member Texas Institute of Health Care Quality and Efficiency, a board of medical professionals appointed by then-Governor Rick Perry (R), recommended that the state’s health commissioner be allowed to negotiate with the federal government a Texas-specific solution to expand health coverage with available federal funds. The Institute was created in 2011 to identify evidence-based approaches to improve health care and reduce costs. Any recommendations by the Institute are not binding on the Legislature, which has maintained its opposition to Medicaid expansion.

VIRGINIA Governor Terry McAuliffe (D) is a strong supporter of Medicaid expansion and has had some bi-partisan support in 2014 for an expansion from the Senate. Following a stalemate last year with the expansion tied to the state’s budget, the House has reiterated its opposition to expansion during the current legislative session. Neither the House (R) nor the Senate (R) has included Medicaid expansion in their budget proposals for the 2015 session.

WEST VIRGINIA With support from Governor Earl Ray Tomblin (D), West Virginia began operating an expanded Medicaid program on January 1, 2014. The state implemented a standard expansion and did not seek waivers for alternate models. Pre-expansion expectations estimated about 63,000 new enrollees during the first year, with 118,000 expansion enrollees expected by 2018. Recent figures from CMS estimate that as of March 2014, 103,662 individuals, or 22 percent of total enrollment, had enrolled in Medicaid under the expansion.