Greg Bell: The Medicaid dilemma
What to do about Medicaid? Costs are burgeoning. Federal outlay for Medicaid is
Still, whether you like it or hate it, Medicaid is apparently here to stay — at least until federal and state governments can’t fund it anymore.
Medicaid pays the medical bills for one in five Americans. According to the
And
Established in 1965 as part of the War on Poverty, Medicaid has become an essential part of the American safety net for the disabled, pregnant women, children, low-income families with children and low-income persons needing long-term care.
The federal government has historically paid about 70 percent and the state around 30 percent for Utah’s Medicaid program.
The Affordable Care Act (ACA) changed Medicaid eligibility dramatically for people in states that expand Medicaid. First, it extended eligibility to everyone earning up to 138 percent of the federal poverty limit (FPL). Second, the federal government’s match for expanded Medicaid recipients was 100 percent in 2014-2016, ratcheting down to 90 percent in 2020 and thereafter. Even with such a rich federal match rate, 18 red states including
But it’s not all roses. Many expansion states have seen membership and expenditures grow far beyond projections. Even with the 90 percent federal match, states are struggling to keep up with costs. Our Legislature didn’t expand Medicaid primarily out of fear it would break the bank at some point.
The 2018 ballot will ask voters to make an important choice on Ballot Proposition 3 to fully expand Medicaid. The measure extends eligibility to everyone under age 65 who earns less than 138 percent of the federal poverty level (
There is more: In the 2018 legislative session, the
Enhanced match
Eligibility would be extended to those earning 100 percent of FPL or less, but asks the federal government for the enhanced 90 percent match.
Work requirement
The bill requires able-bodied recipients to have a job, be looking or training for a job.
Enrollment/expenditure caps
Probably most important for the legislative Republican majorities, the measure allows caps on enrollment when expenditures exceed appropriated funds. Between 70,000 and 90,000 would become eligible for Medicaid under HB472.
HB472 faces serious hurdles:
Enhanced match
The federal government has never approved expanding only to 100 percent of FPL with the enhanced federal match; many doubt they have the legal ability to do so.
Work requirements
Some work requirements in other states have been disallowed. The Obama administration saw Medicaid as an entitlement that cannot be conditioned on anything beyond proving eligibility.
Enrollment/expenditures caps
Usually, the federal government imposes no caps in Medicaid funding, and caps for states have not been generally allowed either.
Disclosure: The author is the president of the
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