A Medicaid expansion plan approved for Iowa earlier this month offers some hope that a Medicaid compromise might also be worked out for Kansas.
The effort also should be bolstered by the work of the Kansas Hospital Association, which has hired a former secretary of Health and Human Services — former Republican governor of Utah Mike Leavitt — to help craft a Medicaid expansion plan that Gov. Sam Brownback and state legisaltors might support.
The Iowa plan approved by the federal Centers of Medicare and Medicaid Services uses federal dollars to finance the purchase of private health insurance for low-income people who are eligible for Medicaid under the Affordable Care Act. In Iowa, residents who are above the poverty line will pay a small portion of their insurance premiums; those below the line will pay nothing. The cost of their care will be borne initially by the federal government and transferred over time to the state. Like Kansas, Iowa previously had declined to participate in the expanded Medicaid program.
Kansas currently has some of the strictest requirements in the nation for Medicaid assistance. Non-disabled adults with children are eligible for Medicaid only if their incomes fall below 32 percent of the federal poverty level. That’s about $6,250 a year for a family of three. That means a parent who works half-time for minimum wage would make too much to qualify for Medicaid, although his or her children would be covered. Childless adults without disabilities in Kansas don’t qualify for Medicaid under any circumstances.
The Iowa Medicaid compromise, and a similar plan being pursued by Arkansas, may be the basis for Kansas and other states that have declined Medicaid expansion. Brownback reportedly said in a recent interview that he was waiting to see how flexible the federal government was willing to be with states. Approval of the Iowa plan offers evidence of that flexibility.
Medicaid expansion would be good news not only for low-income Kansans but for the Kansas hospitals that provide some of their care. One reason that the hospital association has hired an outside consultant is that its members stand to lose an estimated $66 million in federal Medicaid payments in the coming year. Those federal tax dollars will go to other states while Kansas hospitals continue to provide care to indigent patients without the full benefit of Medicaid reimbursement. That could leave many smaller hospitals in the state in a struggle for financial survival.
The Kansas governor and legislators say they haven’t closed the door on Medicaid expansion. If that is true, the approval of Iowa’s plan seems like a perfect opportunity to open that door a little wider and allow Kansas to negotiate a common sense compromise on Medicaid funding.