Haslam talks with other governors, says he’ll decide on Medicaid expansion decision this month

By Lucas Johnson, Associated Press
NASHVILLE, Tenn. — Gov. Bill Haslam said Friday that he’s talked with nine Republican governors who have expanded Medicaid for low-income people in their states, and he plans to announce what he will do by the end of the month.

Haslam has been heavily criticized for refusing last year to agree to $1.4 billion in federal funds to cover about 180,000 uninsured Tennesseans under the terms the money was offered.

The Republican governor wrapped up budget hearings Friday, and among the last was TennCare, Tennessee’s version of Medicaid. After the TennCare hearing, Haslam told reporters that he talked with Health and Human Services Secretary Sylvia M. Burwell this week and that he plans to make a decision by Christmas.

Haslam has said he’s trying to get federal officials to approve an alternative plan, one that is acceptable both to Washington and to largely skeptical Tennessee lawmakers, who must approve any deal under a law passed earlier this year. He said the GOP states that expanded Medicaid have been part of the conversations with Washington.

“As we’re talking with Washington, we’re trying to find out, here’s what they’ve proposed, what are you likely to approve here?” Haslam said.

Health care advocates are becoming increasingly frustrated with Haslam’s delay, particularly because those nine Republican governors expanded Medicaid and at least three more are in discussions with federal officials.

“Other Republican governors have successfully negotiated deals … using the federal dollars to fund their plans,” said Michele Johnson, executive director of the Tennessee Justice Center, a leading advocate for enrollees in TennCare. “They have shown that it is possible, and that Tennessee should be able to do the same thing.”

The nine Republican-governed states that have expanded Medicaid are Arizona, Iowa, Michigan, Nevada, New Jersey, New Mexico, North Dakota, Ohio and Pennsylvania.

Last week, Wyoming, which has a Republican governor, released a plan to expand Medicaid. The proposal, which still has to win federal and state legislative approval, would provide Medicaid coverage to an additional 17,600 low-income people, according to the state’s health department.

Under the plan, those earning 100 to 138 percent of the federal poverty level — for a single person, $11,670 to $16,105 a year — would have to pay monthly premiums. The premiums could range from about $20 to $50 a month, depending on household size and income, according Kim Deti, spokeswoman for the Wyoming Health Department.

She said people earning less than 100 percent of the poverty level would not have to pay monthly premiums. However, they could owe small co-payments for certain services. Deti said those deemed “medically frail” would be enrolled in traditional Medicaid.

“We’ve proposed a plan that the governor believes to be acceptable,” she said.

In Tennessee, a recent Vanderbilt University survey of about 950 registered voters showed 56 percent supported expanding Medicaid coverage.

Health care advocates say the state’s youngest citizens are among those who would benefit from an expansion.

Mary Nell Bryan is president of the Children’s Hospital Alliance of Tennessee. She said studies show that children are likelier to get access to health care if their parents have it.

“Even if kids are eligible for coverage, their parents are not as likely to take them to a doctor for check-ups and immunizations if the parents are not getting routine health care as well,” Bryan said.

Note: Meanwhile, there’s also the option of shrinking Medicaid rather than expanding it, reports Richard Locker:
If TennCare were forced to cut 7 percent of its budget during the next fiscal year, it would slash payments to doctors, hospitals and other providers by 4 percent and increase the assessment that hospitals and nursing homes pay from the current 5.5 percent of their net patient revenue to 6 percent, TennCare officials said Friday.

All executive branch departments were asked to prepare contingency plans for cuts of up to 7 percent, but Haslam cautioned after the TennCare presentation that cuts of that magnitude may not necessarily occur.

TennCare pays physicians, hospitals and other providers and sets rates for services. If the cuts have to be implemented, the 4 percent reduction would start with the budget year that begins next July 1.

Hospitals and nursing homes also pay 5.5 percent of their net patient revenue to the state for Medicaid, which the state leverages for additional federal funding for the program. The money is eventually returned to hospitals and nursing homes through Medicaid payments.

TennCare now covers 1.3 million low-income or disabled Tennessee residents, at a total cost projected at $10.3 billion during the next budget year. The federal government pays the bulk of that, leaving the state to pay $3.3 billion.

Gordon told the governor that without cuts, TennCare’s costs are expected to rise by a total of $279.3 million next year, about $66.2 million of which would be the state’s share.