Kaiser survey eyes federal funding for Medicaid, CHIP enrollment

With unemployment high and state budgets tight, a recent survey by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured found nearly all states maintained or made targeted expansions of their Medicaid and Children's Health Insurance Program eligibility and enrollment rules in 2010. The survey found that coverage in the programs held steady and, in some cases, was expanded for children. Despite enrolling more children, though, eligibility for low-income adults continued to lag. The report, "Holding Steady, Looking Ahead: Annual Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and CHIP, 2010-2011" attributed much of the stability of the state-run program to federal funds made available through the American Recovery and Reinvestment Act of 2009. The money from ARRA was tied to states maintaining their Medicaid coverage policies. ARRA assistance to states is set to expire on June 30 and there is concern that with, many states in the midst of significant budget shortfalls, Medicaid programs will be targeted for cuts even as more people are in need of coverage. "Millions of American families have turned to Medicaid and CHIP as incomes have declined after losing jobs and the health insurance that often goes with them," said Diane Rowland, executive vice president of the foundation and executive director of the KCMU. "Keeping these programs stable and strong has helped protect children and avoid an even larger increase in the nation's 50 million uninsured and will be key to ensuring the success of health reform implementation over the next few years." Keeping Medicaid stable between now and 2014, when most of the health reform laws kick in, could be a challenge. Last week, 33 state governors asked Washington lawmakers to get rid of a provision in the new law that would reduce federal matching funds to states that reduce Medicaid enrollment. Even with federal funds supplying roughly 57 percent of the funding for state Medicaid programs, most states are struggling to pick up their portion of the tab. Not surprisingly, Medicaid rolls have expanded during the recession, with enrollment in 2009 totaling 47.8 million, up from 42.6 million in 2008. "The federal requirements force governors to cut other critical state programs, such as education, in order to fund a 'one-size-fits-all' approach to Medicaid," the governors said in a letter to federal officials. Arizona Gov. Jan Brewer has been one of the most vocal critics of the Medicaid program. She has faced criticism during the past couple of months after cutting Medicaid funds for certain types of transplant procedures. In a mid-December letter to House Speaker John Boehner (R-Ohio), Brewer noted that Arizona's Medicaid spending has increased 63 percent since the beginning of the recession and urged him to relax some of the provisions to qualify for federal funds. "We cannot afford this increase without gutting every other state priority such as education and public safety," she said. "Put quite simply, we have a Medicaid program that is not affordable or sustainable."