AHA Asks HHS About Medicaid Expansion In Wake of Supreme Court's Recent Ruling

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Joining the list of groups seeking guidance from federal health officials, the American Hospital Association Aug. 20 asked for more information about how the Department of Health and Human Services plans to implement the health care law's Medicaid expansion.

In a letter to HHS Secretary Kathleen Sebelius, the AHA said its 5,000 member hospitals need clarification on several issues in the wake of the U.S. Supreme Court's decision in June that allows states to decide whether they will participate in the Medicaid expansion.

The letter, signed by AHA President and Chief Executive Officer Richard Umbdenstock, noted, “Because hospitals are a central component of the federal-state partnership that serves as the basis for the Medicaid program, we want to ensure that the program operates effectively for both health care providers and their patients.”

The Medicaid expansion as enacted would have provided coverage to adults younger than 65 with income up to 133 percent of the federal poverty level (FPL), opening eligibility to some 16 million new enrollees if all states participated.

The high court's decision said that HHS could not threaten states with the loss of their existing Medicaid funds if they chose not to participate in the expansion, in effect making the program voluntary on the part of the states.

Since the high court's decision, groups ranging from the Republican Governors Association to state Medicaid directors have sought guidance from the government on how the Medicaid expansion will be handled (133 HCDR, 7/12/12). Lawmakers on Capitol Hill have also sought answers from HHS on a host of questions on implementation of the Patient Protection and Affordable Care Act (see related article).

The AHA letter included 12 questions about the Medicaid expansion, including:

• Will HHS/Centers for Medicare & Medicaid Services use the flexibility of Section 1115 waivers to encourage states to expand their Medicaid programs, and

• Are individuals with income between 100 percent and 138 percent of the federal poverty level eligible for subsidies through the exchange?


Groups Ask About 'Partial Expansion.'

One issue raised by many stakeholders, including AHA, is whether states will be permitted to implement a so-called partial Medicaid expansion. Under PPACA as enacted, people with no income or low income up to 133 percent of the FPL would be eligible for Medicaid.

With state participation in the Medicaid expansion now voluntary, AHA and other stakeholders have asked HHS whether states can open Medicaid to people with income not as high as the 133 percent FPL income threshold set in PPACA.

In its letter, AHA asked that question as follows:

• “Can states expand Medicaid coverage to certain populations (i.e., populations based on an income threshold below 100 percent of the FPL, or parents of Medicaid or Children's Health Insurance Program enrollees, or single, childless adults)?”

To date, CMS has not provided a response to the question.

At a recent HHS forum on PPACA implementation, Cindy Mann, director for Medicaid and CHIP Services at CMS, said the agency is “still considering” whether states will be allowed to go only part way toward the full Medicaid expansion, which is scheduled to begin in 2014 (157 HCDR, 8/15/12).

By Ralph Lindeman  

The AHA letter is at http://www.aha.org/advocacy-issues/letter/2012/120820-let-umbdenstock-sebelius.pdf.

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