Right now, it looks like the signature drive to get Medicaid Expansion on the Oklahoma ballot will collect more than enough valid signatures:
— Bruce Japsen (@brucejapsen) October 24, 2019
This is first step for the expansion effort. The second step is to win the vote. The third step is to win the implementation.
That third step is tricky. Three states’ voters west of the Mississippi River passed Medicaid Expansion in the November 2018 general election.
Utah has engaged in a complex series of expansion waiver efforts. The state government started with a proposed partial expansion to only 100% Federal Poverty Line. The Center for Medicare and Medicaid Services (CMS) rebuffed that waiver. Now Utah has a roll-out of full expansion but with significant work requirements and benefit clawbacks via waiver.
Idaho has submitted a number of waivers. They will not be getting a straight up expansion via state plan amendment that the voters approved.
Nebraska has taken their time. The first enrollment in the Medicaid Expansion approved in November 2018 won’t happen until October 1, 2020. Nebraska will also have a complex system of benefits, reporting requirements and paperwork friction:
Just read NE Medicaid waiver in full – its so complex! I count about 10 different kinds of rules that a Medicaid beneficiary must comply with to get the "Prime" benefits package.
Lots of people won't bcuz its so confusing and then will lose their dental/vision benefit. Ouch https://t.co/3htUEJeCAb
— Joan Alker (@JoanAlker1) October 27, 2019
Winning a spot on the ballot is a necessary but grossly insufficient step to implementing Medicaid Expansion when state elites are strongly dis-interested in that policy choice.