Medicaid Chief Thanks State Leaders, Even As They Skip Expansion Option

It wasn’t all hugs and kisses,  but the nation’s top Medicaid official on Tuesday told Medicaid directors from around the country that she was proud of the job they were all doing — even though half of their states opted against expanding the state-federal health insurance program for the poor under the health law.

“Hats off to you,” Cindy Mann, director of the federal Center for Medicaid and CHIP, told a meeting of the National Association of Medicaid Directors. “I am enormously encouraged by the commonality of purpose.”

She credited states for simplifying eligibility and enrollment and exploring new ways of paying doctors and hospitals to improve care and save money. “The extraordinary amount of change going on in every state — regardless of if you are taking the opportunity to provide more coverage to more people — is the most significant since the inception of the program,” she said.

The nation’s Medicaid directors oversee a program that covers 72 million people a year across the country at a cost of more than $430 billion, according to the association.

Mann has been the Obama administration’s point person dealing with states exploring expanding Medicaid since the health law was approved in 2010. The Supreme Court in 2012 gave states the option whether to expand the program to cover everyone under 138 percent of the federal poverty level, or nearly $15,900 for an individual. Most Republican-led states have balked at the move even though the federal government pays the full cost for the first three years and after that states have to pay up to 10 percent.

Mann stressed that state Medicaid programs have always had different benefits and services so the situation today is nothing new. But the Affordable Care Act intended to make sure people received the same coverage no matter where they lived.

Darin Gordon, president of the Medicaid directors association and director of the Tennessee program, said more states — including his — would expand Medicaid if the Obama administration allowed them to force recipients to pay more of their share of costs through higher co-pays. He said the change is necessary to drive patients to make better decisions. States could charge co-pays to penalize bad behavior such as misusing hospital emergency rooms and reward good behavior by reducing co-pays for refilling prescriptions and getting other necessary services, he said.

Mann responded by saying states won’t solve their Medicaid budget woes on the back of poor recipients. The administration has long blocked efforts by states to charge Medicaid patients — particularly those making less than the federal poverty level of $11,490 for an individual — any more than nominal fees for services. Mann said states should rather target their efforts to save money at making sure the sickest patients and the elderly and disabled, get better care. She noted 5 percent of Medicaid beneficiaries make up half the costs of the program.

Tennessee has been in talks with administration officials for months about expanding the program. “We need something to say you can’t misuse the system repeatedly,” Gordan said of the need for higher co-pays. “From the perspective of the states we do not think we are asking for anything that is harmful to our recipients.”