Four states maneuver on Medicaid expansion


Georgia Gov. Nathan Deal (R), right, isn’t about to expand Medicaid (Erik S. Lesser/ European Pressphoto Agency)

Faced with the prospect of tens of millions, if not hundreds of millions, in federal funding, states are racing to find politically palatable ways to expand Medicaid. Here are the four states moving this week toward — or in one case away from — expanding Medicaid to cover those earning up to 138 percent of the federal poverty line:

South Dakota: Officials have begun negotiating with the Department of Health and Human Services to find flexibility in expanding coverage. HHS officials have started asking questions of their South Dakota counterparts, in part at the urging of state legislative Democrats, who want to give Gov. Dennis Daugaard (R) the political cover he needs to accept the federal funding.

Daugaard has asked if his state could expand Medicaid to cover those who make up to 100 percent of the poverty limit, $11,670 for an individual and $23,850 for a family of four. Those who make between 100 percent and 138 percent of the federal poverty limit would receive subsidies to pay for private insurance through the federal health-care exchange.

Time is running out, though: The South Dakota legislature is only in session for another two weeks. Even if HHS and South Dakota come to an agreement in principle, the waiver process would take weeks to complete. Daugaard said last week he has the unilateral authority to expand Medicaid, although he said he would consult with legislative leaders before taking action.

New Hampshire: A bipartisan proposal dubbed the “New Hampshire Health Protection Program,” one of several programs that would expand coverage through what proponents call the “private option,” is gaining support in the legislature while activist Republicans move to block it. State Senate Majority Leader Jeb Bradley (R) defended the bill before the Merrimack County Republican Party, which promptly voted to oppose the legislation.

The bill, a compromise struck between Republicans and Gov. Maggie Hassan (D), is expected to pass the Republican-controlled Senate, the Union Leader’s John DiStaso reports. It will likely sail through the Democratic-led House.

Maine: Two Republican lawmakers have proposed expanding the state’s Medicaid program to cover about 60,000 additional low-income residents and create a managed care system for all Medicaid recipients. The managed care system would help reduce costs, an element designed to attract Republican votes.

But the bill’s future is uncertain. It passed the legislature’s Health and Human Services Committee on a party-line 7 to 5 vote Monday, although opposition from several key Republicans has Democrats worried they won’t have the votes to override Gov. Paul LePage’s (R) expected veto. Democrats fell three votes short of overriding a veto last year.

LePage’s administration is campaigning against the expansion.

Georgia: Republicans in the state legislature don’t want Gov. Nathan Deal (R) to take Medicaid expansion into his own hands. The state House on Monday voted to strip Deal of the power to expand Medicaid unilaterally, on a party-line vote.

Deal had already ruled out expanding Medicaid. The legislation, though, would mean that if Deal is upset this year by state Sen. Jason Carter (D), the Democrat wouldn’t be able to broaden the program later.

The bill now heads to the Senate.

Reid Wilson covers state politics and policy for the Washington Post's GovBeat blog. He's a former editor in chief of The Hotline, the premier tip sheet on campaigns and elections, and he's a complete political junkie.
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