Limits on the “Private Option” for Medicaid Expansion

The trouble being experienced by Arkansas in continuing its “private option” for expanding Medicaid has cooled the jets somewhat of those inclined to predict that it reflected an avenue for the speedy adoption of the expansion by Republican-controlled states. But it’s true some such states are noodling around with private option schemes or have already been exploring them with HHS. So to get a sense of where things actually stand, check out a useful Stateline report from Christine Vestal that illustrates some of the bright lines HHS has set out but that Republican governors and legislators are expected to cross or blur:

New Hampshire, Pennsylvania, Tennessee, Utah and Virginia are currently considering Medicaid expansion. Governors in Florida, Indiana, Missouri and Montana have declared their support for some form of Medicaid expansion, but no action is expected this year in those states.

Of all the states currently considering expansion, New Hampshire may be the only one that succeeds in expanding coverage this year.

Pennsylvania Gov. Tom Corbett is demanding a work requirement that HHS is likely to reject. Tennessee may be going too far in demanding copayments by beneficiaries. Utah could run afoul of requirements that all those with incomes below 138% of the federal poverty line qualify under the expansion. Indiana’s effort to use expansion money for a system of health savings accounts is very unlikely to pass federal muster.

The bottom line is that the window for the most generous phase of ACA’s Medicaid expansion will be closing pretty soon and it’s not entirely clear that the number of participating states is on a steady rise. There could be a ballot initiative in Montana (or possibly, though it’s much less likely, in Louisiana) this fall to force an expansion, but it’s unclear how well it will do with a midterm electorate.

So despite the Obama administration’s eagerness to help state-level Republicans find a way to make the Medicaid expansion their own, it’s looking like relatively few will be able to take “yes” for an answer.

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Ed Kilgore

Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.