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Mark's Musings - 2017 Legislative Session
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This Week in the Legislature
Medicaid


With the governor’s veto of the Medicaid expansion legislation and his accompanying veto message, I thought you might find it helpful to have some background on the issue.
 
What is Medicaid?
Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program (CHIP), provides health coverage to over 72.5 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities. Medicaid is the single largest source of health coverage in the United States, and for Kansas represents about 25% of the state’s general fund. The federal government matches the state’s Medicaid expenditures at 54%. However, for state’s that expand their Medicaid program to cover residents who earn less than 133% of the federal poverty level, the federal government matches at a 95% rate. That rate slowly declines to 90% in 2020 and years thereafter. The 2017 guidelines for federal poverty level in Kansas for a single person is $12,060 per year, and for a family of four it is $24,600 per year.
    
Most states (31) and the District of Columbia have chosen to expand coverage to adults below the 133% of poverty guidelines, and those that have not yet expanded (19) may choose to do so at any time. No state that has expanded Medicaid has repealed the expansion, regardless of what political party is in charge.

KanCare


KanCare is the program through which Kansas administers Medicaid. Launched in January, 2013, KanCare is delivering care to more than 415,000 people across the state. Kansas has contracted with three health plans, or managed care organizations (MCOs), to coordinate health care for all people enrolled in Medicaid. The KanCare health plans are Amerigroup of Kansas, Inc. (Amerigroup), Sunflower Health Plan (Sunflower), and UnitedHealthcare Community Plan of Kansas (United).
 
The Kansas Department of Health and Environment (KDHE) and the Kansas Department for Aging and Disability Services (KDADS) administer KanCare. KDHE maintains financial management and contract oversight of the KanCare program while KDADS administers the Medicaid waiver programs for disability services, mental health and substance abuse, as well as operates the state hospitals (such as Larned State Hospital and Osawatomie State Hospital) and institutions. Each Medicaid consumer is assigned to one of the KanCare health plans. KanCare health plans are required to coordinate all the different types of care a consumer receives. The goals of the KanCare program are to improve overall health outcomes while slowing the rate of cost growth over time.
 
(Much of this information was taken from the KanCare website.)
 

What does the Medicaid Expansion Legislation
(HB 2044, aka KanCare Bridge to a Healthy Kansas) Do?


Following are some of the key attributes of the bill:
 
  1. On or after January 1, 2018, medical assistance shall be granted to any adult under 65 years of age, who is a United States citizen or legal resident and who has been a resident of Kansas for at least 12 months, who is not pregnant and whose income does not exceed 133% of the federal poverty level, as it exists on the effective date of this act.
  2. The department of health and environment (KDHE) shall refer all non-disabled adults in the KanCare Bridge to a Healthy Kansas program who are unemployed or working fewer than 20 hours a week, to the state’s existing workforce training programs and work search resource.
    1. Full-time students shall be exempted from the referral required above for each year they are enrolled in a postsecondary education institution or technical school.
    2. Parents with minor children in the home are exempt from the referral required above at the discretion of KDHE.
  3. If, at any point, the percentages of federal match available to the program for coverage of program participants is less than 95% in 2017, less than 94% in 2018, less than 93% in 2019 or less than 90% thereafter, KDHE shall terminate the KanCare Bridge to a Healthy Kansas program over a 12-month period, beginning on the first day that the federal medical assistance percentages fall below such amount
  4. Creates the KanCare Bridge to a Healthy Kansas program drug rebate fund. Moneys in the KanCare Bridge to a Healthy Kansas program drug rebate fund shall be expended for medicaid medical assistance payments for KanCare Bridge to a Healthy Kansas program beneficiaries.
  5. Creates the KanCare Bridge to a Healthy Kansas program privilege fee fund for Medicaid medical assistance payments for program beneficiaries.
  6. A premium assistance program would be required to contain eligibility requirements similar to those for the Program and provide that an individual’s payment for a health insurance coverage premium cannot exceed 2 percent of the individual’s annual income.
(The above information was taken from the bill and its supplemental note.)

Medicaid Expansion Votes


House – Feb. 23, 2017 – 81 ayes, 44 nays (Need 84 to override)
Senate – March 28, 2017 – 25 ayes, 14 nays (Need 27 to override)
 

The Governor's Veto Message

March 31, 2017
 
In his message, the governor highlighted three criteria that must be met before he would approve any Medicaid expansion proposal. They are:
  1. Include a plan to eliminate the inherited waiting list for services to our disabled community;
  2. Include work requirements to help Kansans escape poverty;
  3. Have a neutral impact on the state budget.
He also stated “the cost of expanding Medicaid is irresponsible and unsustainable.”
 
He admonishes those who support expansion by saying it will negatively affect those already on the waiting list, and he will not place “able-bodied” people ahead of those that have been waiting in line for years. Somehow, he has made a connection between people waiting to get services and those wanting to get health insurance. In fact, per state data compiled by the Kaiser Family Foundation, in expansion states history shows waiting lists go down. Eleven expansion states (AZ, DC, DE, HI, MA, ND, NH, NY, OR, NY, RI, & VT) had no Home and Community Based Service (HCBS) waiting list in 2014 and 2015. Nine expansion states (AK, AR, CA, IA, IN, MI, NM, PA & WA) decreased their HCBS waiting list from 2014 to 2015. Indiana expanded Medicaid in 2015 and experienced a double-digit percent decrease (64%, or 3,381 people) in its HCBS waiver waiting list between 2014 and 2015. Ten expansion states did see an increase in the HCBS waiting list. However, that increase was 250% less than the increase experienced by non-expansion states. The data doesn’t support the governor’s contention.
 
The work requirement is another criterion with questionable support. Sounds logical to have people work to get benefits, and the expansion plan makes people search for work, but what if they can’t work or are too sick (due to lack of health care)? Many of those who would seek health care are the working poor, working 3 or 4 jobs just to get by. In expansion states, evidence shows that people covered by expanded Medicaid work more hours and earn more than similar people in states without expansion. The evidence suggests the reason is because they aren’t as sick as before. His characterization of this class of people as some kind of second-class citizen is inaccurate and misguided.
 
Budget impact should be neutral and if the ancillary growth factors occur as evidenced in other states, it would likely be positive with this expansion proposal. For instance, in 2014, Kentucky’s expanded Medicaid program created 12,000 new jobs. In New Mexico, 4,000 new jobs in the healthcare and social assistance industry were created in 2014. Arkansas hospitals’ uncompensated care decreased 56% in 6 months. Kentucky hospitals saw a 60% drop in uncompensated care. As of September 2015, the percentage of rural hospitals at risk of closure had doubled in non-expansion states as compared to expansion states. The data is showing me the benefits to expansion for a state’s economy.
 
Some have questioned the burden expansion would place on the state’s general fund. It’s a question I don’t want to ignore because it is an important one. Some of my constituents have forwarded opinion articles talking about the unanticipated increase in the number of Medicaid recipients once it was expanded in states. The implication was this increase swamped the state’s budget so badly that it was on the verge of fiscal collapse. Experience is a great teacher, so I looked at one of the nearby states that expanded recently, Arkansas. Their initial projected costs were slightly higher than the actual costs and their projections for future years continue that trend. When hearing the governor say states with expansion have seen cost overruns by 110% and double the projected enrollees, the obvious follow-up question is “if all the expansion states’ budgets are terribly underwater, why has not one state repealed their expansion law?” My guess is that their residents support it and the state government has been able to manage it.
 
Expansion is not a plan like many the state prepares…gather a committee, spend days on meetings and testimony, write a report then place it on the shelf never to be read again. It’s a dynamic process and needs to be adjusted along the way as none of us have a crystal ball that guarantees 100% success. Many expansion states are adjusting for increased accountability and savings. That’s not a negative, it’s the way the process should work. I support regular accountability reports about the effectiveness of the expansion, and subsequent adjustments.
 
I respect the many opinions I have heard on this subject over the last year from constituents, legislative colleagues, and yes even the governor. For me and the majority that have taken the time to contact me on this subject, expansion of Medicaid in a responsible and accountable manner is a benefit to Kansas. I will vote to override the governor’s veto.


Contact Me


If you have questions about the activities in my committees or want to share your views on other issues before the legislature, please feel free to e-mail, text or call me. If you are visiting the Capitol, please stop by to say hello. I may be in a committee but my assistant, Deborah, will be glad to take a note.
 
Representative Mark Schreiber
Visit my website at http://www.schreiberforkansas.com/
 
Home
1722 Yucca Lane
Emporia, KS   66801
Home: 620-342-6954
Cell: 785-230-0897
Email: mschreiber82@gmail.com
 
 
Legislative Office
Room 167-W, State Capitol Building
300 SW 10th Street
Topeka, KS   66612
Phone: 785-296-2721
Email: mark.schreiber@house.ks.gov

 Paid for by Mark Schreiber for Kansas House – Cindy Lore, Treasurer
 

Contact Mark

 

StateHouse Office

Room 167-W
300 SW 10th Street,
Topeka, KS 66612
Phone: 785-296-2721
Mark.Schreiber@house.ks.gov

Home

1722 Yucca Lane
Emporia, Kansas 66801
Phone: 620-342-6954
mark@schreiberforkansas.com  
 

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