Medicaid Expansion

via North Carolina Governor Roy Cooper:

Today, Governor Cooper announced that more than 400,000 North Carolinians now have access to health care through the state’s Medicaid expansion following record enrollment numbers and a coordinated campaign to enroll North Carolinians across the state.

“So many younger, working people desperately need affordable health insurance and Medicaid Expansion fills the bill for thousands of them and with people all the way through age 64,” said Governor Roy Cooper. “This milestone and the speed at which we’ve reached it shows just how lifechanging Medicaid expansion is for our state and we will continue to get more eligible North Carolinians enrolled.”

February 16th:

I strongly suspect that at least one of the remaining holdout states will join the expansion crowd this year, most likely Georgia, Mississippi or Alabama...but it likely will be some state-specific variant as described above. Stay tuned...

...As I noted, however, in all three [states] it's pretty likely they'll go with at least a partially privatized version as Arkansas has instead of a "clean" expansion of Medicaid proper.

Of course, as one Alabama-based advocate put it...

Mississippi better not beat us to expand.

— Jane Adams (@janeadamsid) February 16, 2024

Well, it looks like Ms. Adams may end up being disappointed...

BREAKING: The Mississippi House just passed Medicaid expansion by a 96-20 vote.
That's more than enough to overcome a veto from Gov. Tate Reeves.
It now heads to the Senate.

Two weeks ago:

As I concluded in the last piece:

I strongly suspect that at least one of the remaining holdout states will join the expansion crowd this year, most likely Georgia, Mississippi or Alabama...but it likely will be some state-specific variant as described above. Stay tuned...

...As I noted, however, in all three [states] it's pretty likely they'll go with at least a partially privatized version as Arkansas has instead of a "clean" expansion of Medicaid proper.

Of course, as one Alabama-based advocate put it...

Mississippi better not beat us to expand.

— Jane Adams (@janeadamsid) February 16, 2024

Well, it looks like Ms. Adams may end up being disappointed...

Just a week ago, I posted...

I strongly suspect that at least one of the remaining holdout states will join the expansion crowd this year, most likely Georgia, Mississippi or Alabama...but it likely will be some state-specific variant as described above. Stay tuned...

And just a few hours ago, I posted a piece headlined, "Which Holdout State Will Be Next To Finally Expand Medicaid??"

Well, it looks like we may have our answer already. Via Ashton Pittman of the Mississippi Free Press:

A Medicaid expansion bill will arrive in the Mississippi Senate by Monday, beginning a process that could provide health care to about 230,000 working Mississippians, Lt. Gov. Delbert Hosemann says.

via the North Carolina Dept. of Health & Human Services:

NC Medicaid Expansion Continues to Bring Health Care to More North Carolinians

PRESS RELEASE — As of Feb. 1, 2024, 346,408 newly eligible North Carolinians are enrolled in Medicaid and now have access to comprehensive health care, according to the North Carolina Department of Health and Human Services’ Medicaid Expansion Enrollment Dashboard. NCDHHS released an updated the dashboard today, and it includes enrollment data as of Feb. 1, 2024. This number is more than half of the anticipated 600,000 people who are newly eligible for coverage, expected to enroll in Medicaid expansion over the next two years.

"In the first two months we have already enrolled over half of the eligible people," said NC Health and Human Services Secretary Kody H. Kinsley. "These individuals and families are seeing providers, utilizing preventative and specialty care, and getting life-saving prescriptions."

Georgia is one of just ten remaining states which is still holding out on fully expanding Medicaid to all legal residents earning up to 138% of the federal poverty level under the Affordable Care Act. Instead, back in 2019, GOP Georgia Governor Brian Kemp submitted a Section 1115 waiver which included a plan to partially expand Medicaid to some uninsured Georgia residents...except with a work reporting requirement for enrollees attached to it.

The program was called "Georgia Pathways," it was approved by the Trump Administration, and unlike several other states which had work requirement provisions shot down by various judges, Georgia's managed to slip through. It was scheduled to go into effect in 2021 and was supposed to be valid until September 30, 2025 before having to be resubmitted for renewal.

The incoming Biden Administration's HHS Dept. put the kibosh on the work requirement provisions of the program. Georgia successfully challenged the administration and Georgia Pathways went into effect last summer...but is still currently scheduled to sunset next September.

Back in November, I noted that Georgia, one of the ten states STILL refusing to expand Medicaid coverage to hundreds of thousands of low-income residents a decade after they could have done so under the ACA, may finally be coming around...albeit via a rather silly & inefficient method. via the Atlanta Journal-Constitution:

Could Georgia adopt an Arkansas-style Medicaid plan?

Senior Republicans see an opening for a health care overhaul

Key Republicans say they’re open to legislation that would add hundreds of thousands of poor Georgians to the state’s Medicaid rolls — and bring in billions of federal dollars to subsidize it — as part of a compromise to roll back hospital regulations.

I just posted a colorful graph which tracked ACA Qualified Health Plan (QHP) enrollment over eleven years of Open Enrollment Periods.

Below I've done the same thing for ACA Medicaid Expansion. The data comes from the Centers for Medicare & Medicaid Services quarterly Medicaid Budget & Expenditure System reports.

*Unfortunately the MBES reports only run through June 2023, so it's missing 6 months of updates (which have likely shown a small drop in ACA Expansion Medicaid enrollees due to the ongoing Unwinding process). It therefore actually only includes 10 1/2 yrs of enrollment data.

Also keep in mind that if the remaining 10 states had expanded Medicaid under the ACA by now, the grand total would have been several million higher.

No further analysis or comment here; I just think this is a pretty cool graphic...and keep in mind that most of the ~24.5 million people represented here would have been utterly screwed from early 2020 - early 2023 without the Affordable Care Act being in place when the pandemic hit. Click the image for a higher-resolution version; the states are listed on the right-hand side, though they might be difficult to make out (also note that Guam, Puerto Rico and the U.S. Virgin Islands also have a number of ACA expansion enrollees shown):

Mississippi is one of the ten states where ACA Medicaid expansion still hasn't gone through a full decade after it could have.

A few years ago, Medicaid expansion in Mississippi looked like it might actually happen: While the states GOP Governor and Republican supermajority-controlled state legislature opposed it, in May 2021 there was a strong grassroots effort to put a statewide initiative on the ballot to push it through regardless, exactly how it happened in other deep red states like Utah, Nebraska, Idaho and South Dakota.

Unfortunately, just a few weeks later, the Mississippi Supreme Court crushed that effort:

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