Deborah Bachrach, former Medicaid director for the state of New York and now a consultant to states on Medicaid expansion issues, is briefing lawmakers this morning on what other states are doing. “Medicaid is in your hands – you decide what you want to do and how you want to do it,” she told the Legislature’s interim committee on the state’s health coverage gap. “You don’t have complete freedom, it’s a federal-state partnership … but a lot of it is state-directed.”
Bachrach said 31 states have opted to expand their Medicaid programs under the Affordable Care Act, receiving federal funds to do so, and six of those have “used what we’ve been calling alternate expansion models.” That means they’ve sought waivers from federal authorities to make their coverage for the expansion population different from the existing Medicaid program. “If you didn’t want a waiver, just wanted to take your existing program and extend it to more people, go ahead and do it,” she said. “You don’t need special federal approval. But if you want to do it in a way that is not curly contemplated by … federal Medicaid law ... you need a federal waiver ... and that’s what those six states did.”
She said, “States are looking at alternative expansions first and foremost because they want to make Medicaid look more like their state. … Every state is different.” She added, “I’ve been working in Montana, Washington, Oregon, your neighbors – all different.” And all have policy objectives they want to promote in their expansion programs, from personal responsibility to healthy behaviors. “An alternative expansion is your opportunity to do that.”
The six states that currently have waivers for alternative expansions – which is what Idaho has been looking into – are Indiana, Iowa, Michigan, Montana, Arkansas and New Hampshire. Their waivers allow everything from co-pays and premiums to healthy-behavior incentives to assistance with premiums and deductibles for commercial or employer-provided insurance.