A report commissioned by the Kansas Hospital Association details possible models for expanding Medicaid in Kansas.
The more-than-40-page report was created by a firm headed by Mike Leavitt, former Republican governor of Utah and Health and Human Services secretary under President George W. Bush. It aims to examine what a Kansas Medicaid expansion plan could look like, possibly picking and choosing provisions from other states.
The report acknowledges there is “significant opposition” to traditional Medicaid expansion in Kansas, but at the same time, “openness to the idea of a Kansas designed plan to cover the low-income uninsured.”
“The report is intended to provide a menu of options” for legislators, said Tom Bell, president and CEO of the Topeka-based Kansas Hospital Association.
“We hope the report will help spur the dialogue forward and our state will have serious conversations putting together a program unique to Kansas.”
The report uses some examples from other states that could be individualized, including cost-sharing for participants, Health Savings Accounts, wellness programs or requirements that those in the program who are able be working or actively looking for work.
It’s “a way to create some individual accountability,” Bell said.
Kansas lawmakers may be more open to “private market-based” options, the report says.
House Speaker Ray Merrick, R-Stilwell, has said the Legislature is awaiting a decision from Gov. Sam Brownback on Medicaid expansion, while the governor has said it’s up to the Legislature to make a decision.
Many of the state’s legislators are opposed to anything related to “Obamacare,” the report states, which makes it more difficult to discuss traditional expansion under the Affordable Care Act.
They’ve also cited budget concerns. The federal government has said it will pick up the tab for the first three years of expansion, and then pay for 90 percent of the cost of expansion after that, with states picking up the rest.
Originally, the Affordable Care Act envisioned all states expanding Medicaid, but Kansas and 24 other states did not.
About 78,000 Kansans are now in what is called the Medicaid gap. That means they make too much money to qualify for Medicaid, but not enough to qualify for subsidies on the new marketplace at HealthCare.gov.
In Kansas, childless adults do not qualify for Medicaid regardless of income, and adults who make less than about $11,400 individually do not qualify for subsidies on the new marketplace at HealthCare.gov, according to the Kaiser Family Foundation. That’s because the law assumed those individuals would be covered by Medicaid.
Adults with children who make between about $8,950 and $23,550 for a family of four also are in the gap, according to Kaiser.
“The more you look at this issue the more you have to question why our state is not having a serious conversation about a program that works for Kansans,” Bell said.
“There are a lot of options out there that are attractive to policy makers in the state,” he said. “We recognize the political reality, but at the same time we want to move dialogue forward.”