We’re starting to hit the point of no return for any states that want to expand Medicaid with a go live date of January 1, 2015. A state that is authorized to expand Medicaid in anything other than a straight up expansion probably needs a good three to four months to get initial operating capacity built out. They will need six to nine months to get everything working correctly after that. A state that is doing straight up expansion based on current configuration can go live with minimal hassles with a month’s notice.
So what is the state of play on Medicaid expansion for 2015.
Pennsylvania: (95% chance of going live 1/1/15):
Pennsylvania is pushing HealthyPA which is a premium support convoluted workaround to expansion that is needed to get Republicans (who occupy all the blocking positions) around Teabagger primaries. The state is still waiting for final approval from the Centers for Medicare and Medicaid Services (CMS). The state has told their Medicaid Managed Organizations to prepare as if Healthy Pennsylvania will be a go.
The plan is for the health insurers to offer commercial-like insurance to the newly eligible. The newly eligible will have some co-pays and deductibles for some services. This will look a lot like Arkansas or Iowa’s expansion rather than New York’s expansion.
Indiana: (95% chance of going live 1/1/15):
Indiana wants to expand their Healthy Indiana Plan to cover the entire Medicaid expansion eligible population. The HIP 2.0 (yeah, I wonder how much the marketing firm charged for this) plan is an HSA style plan with the state kicking in some of the deductible amount as well as required contributions to an HSA. People who don’t make the required contribution are out of the program for six months. People under the poverty line are pushed into a program that does not cover basic vision or dental.
As I said before, this proposal is better than nothing, but it should only be a starting point for conversations between Indiana and CMS. CMS has not issued a waiver yet. My inclination is that CMS will approve a modified waiver that will bring the acturial value of HIP 2.0 up to 95% or so, and Indiana can then proceed. Mechanically, the infrastructure is in place for HIP 1.0, so the insurers are doing back-end prep work now, and can probably do a fast launch once they get the final approval from Washington.
These are the two highly probable expansion launches. The next three are questionable expansions.
Wyoming (1/1/15 go live 0%, 7/1/15 go-live 75%)
Wyoming has decided that they want to start talking with the Feds about a Medicaid expansion waiver. This most likely means the state will want to go to a premium support model similar to Arkansas, Iowa, Pennsylvania and Michigan. No proposal has been put forward yet, so January 1 is an impossibility. However, if they don’t have too many bells and whistles, CMS has demonstrated an ability to rapidly turn around straight forward waivers, so July 1st is a decent guesstimate.
Virgninia (50% total probability of 2015 expansion, 10% for 1/1, 40% for 4/1)
Governor McAuliffe is calling a special session of the Virginia legislature this fall to focus on Medicaid expansion. He is facing Republican controlled House of Delegates and Senate. The goal is to create a coalition that is 100% of the Democrats and a small faction of Republicans who are seeing massive amounts of federal money passing the state by. Most likely that coalition will not be sufficient for straight up expansion. Instead a premium support model will probably be used.
I think it is a flip a coin chance for any expansion to pass. If Virginia goes premium support, a January 1 launch would be hyper aggressive (I don’t think they could get their waiver in time) and probably result in fiasco. A launch during the spring would give CMS time to issue a waiver, and allow for the construction of the needed backend infrastructure.
Maine (80% 4/1 launch if LePage is defeated)
If Gov. LePage is defeated in November, Maine will expand Medicaid straight up. Assuming enabling legislation is passed and signed in January, a March or April launch is highly probable.