Wednesday, August 8, 2012

Government Accountability Office Looks at Medicaid Expansion


The GAO was asked by Congress to conduct a study on state actions to expand Medicaid under the ACA, and the report was recently released. GAO examined questions pertaining to state responsibilities for implementing the Medicaid expansion, the actions undertaken by the states, as well as state views on the fiscal implications of expanding. 

The 42 page report, will take time to fully digest and interpret for our Wisconsin situation, however, here are some of the major initial findings to note:
  •        The six states included in the study (Colorado, Georgia, Iowa, Minnesota, New York and Virginia) are already taking steps to prepare for the Medicaid expansion, such as determining what changes would need to be made to existing eligibility levels and determination processes to comply with the new, uniform eligibility determination under the ACA – the modified adjusted gross income standard (MAGI). For a look into the new eligibility method, see this report by the Henry J. Kaiser Family Foundation.  
  •        Overall, states reported that further guidance pertaining to MAGI is needed to determine eligibility under different scenarios. It is important to note that, upon the release of the official Medicaid rule by the Center for Medicaid Services (CMS) in March of this year, several webinars have been hosted for additional guidance on the final rule. Even so, states in this study reported a full-range of different scenario guidance is needed. One example of a scenario where such further guidance needed from the GAO report was a child who shares equal time between two households.
  •        In terms of the fiscal implications in the report, GAO used a different method to gathering this information. The GAO used a web-based survey of state budget directors for all 50 states, the District of Colombia and 4 U.S. territories with a response rate of 76%. Further evaluation of the report to determine the impact for Wisconsin is needed.

I think it is important to reiterate that all six of the aforementioned states have already begun taking necessary steps toward implementing the Medicaid expansion. Further, the U.S. Department of Health and Human Services (HHS), has expressed that the findings from the states in the report are helpful in their ongoing efforts for technical assistance and troubleshooting. Such technical assistance and other additional guidance is planned for release later this year. Additionally, the concluding observations of the report note that cooperative efforts by the states and CMS, collectively, will be essential in implementing the expansion. We hope that Wisconsin will take this to heart – and begin to take advantage of the federal support for upgrading our eligibility system, and prepare to fill the gap in BadgerCare.

Lacy Langbecker



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