Medicaid expansion battles persist in Maine and Virginia

Hospital executives have long known that Medicaid expansion has a direct link to uninsured rates that affect uncompensated care.

A recent Kaiser Family Foundation report backs this up. States that have adopted the Affordable Care Act provision have seen coverage gains not only from low income individuals but among prescription drug users, people with HIV, newly diagnosed cancer patients, early retirees, and others.

When adopted, the ACA intended all states to expand Medicaid to allow a greater number of people to be insured. A 2012 U.S. Supreme Court decision gave states the option, with Medicaid expansion adoption in 31 states and the District of Columbia generally following along Democratic and Republican lines. 

Now two states that have struggled to get Medicaid expansion past Republican opposition are using force or compromise to get the program adopted.

In Maine, Republican Governor Paul LePage has five times vetoed a bill to expand Medicaid. Now the state is facing a lawsuit over its delay in enacting the program passed by voter ballot initiative.

On April 30, Maine Equal Justice Partners, among other groups and individuals filed a petition for judicial review of failure or refusal of the Maine Department of Health and Human Services to act.

The petitioners cited Maine HHS Commissioner Ricker Hamilton's failure to submit, within a 90-day window, a state plan ensuring Medicaid eligibility to the Centers for Medicare and Medicaid Services. That effective date should have been April 3, the petitioners said.

Medicaid expansion would bring in $500 million in federal funds per year to the state, according to the Portland Press Herald. LePage has said the Legislature needs to fund the program without raising taxes or dipping into the state's Rainy Day Fund, 

Democrats in Virginia have been trying to pass an expansion bill for years. They may soon get it with the caveat of a waiver for work requirements for beneficiaries, a move supported by Republican lawmakers.

The Department of Health and Human Services is promoting ACA waivers establishing work requirements in expansion states.

Maine is among some non-expansion states that are looking to have work requirements.  

Opponents of Medicaid expansion have said the entitlement program is already broken and was never meant to handle the additional number of people now using it for health insurance coverage.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com