New Jersey Medicaid History and Facts

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Initial Medicaid Implementation: New Jersey initially implemented Medicaid in January 1970, the deadline for states to begin their Medicaid programs if they wanted to maintain their funding for low-income individuals. In the early years of Medicaid, Congress debated the funding level of the FMAP after it was determined that the cost of the Medicaid program was higher than anticipated. A measure was passed that would have reduced the federal share of the payments to as low as 25 percent for some wealthier states. Since New Jersey would likely fit that definition of states that would receive a lower federal match, their senator was the only one to object to the bill and it passed as part of a tax bill in the Senate. At the time, New Jersey was also a very fiscally conservative state and waited until the “deadline” of the end of the Kerr Mills federal dollars in order to accept the Medicaid program. At the implementation of the program, the state elected not to provide for medically indigent category of eligibility.

Key Medicaid Political Issues: In the early to mid-1990s the state went through a retrenchment in its Medicaid program with reductions in hospital spending accompanied with deregulation and mandatory managed care enrollment for cash assistance beneficiaries. These changes were largely due to a change in the political makeup of the legislature and economic conditions in the state. Republicans took control of the legislature at the same time that periodic recessions affected the state budget. This created a climate for reductions in Medicaid spending. New Jersey has taken many steps to address more public health and social determinants of health through its Medicaid program. The state has run programs to provide supportive housing which benefits the Medicaid program. In 2012 the state passed a waiver that created several integrated managed care programs addressing behavioral and social factors that affect health. Maternal mortality and the racial differences in maternal mortality rates have been a concern for the state in recent years.

Medicaid Expansion Implementation: New Jersey began their Medicaid expansion with enrollment beginning in October of 2013 and coverage beginning in January of 2014. New Jersey was one of the five states that decided to expand Medicaid coverage prior to 2014 using a flexibility within the law that allowed states to expand coverage early. However, the state only extended coverage for adults up to 23% of the federal poverty level beginning in April of 2011. Chris Christie was the governor of New Jersey at the time and there was some concern that he may not implement the program as a Republican governor. In the early days of the Medicaid expansion in New Jersey, the state had significant issues redirecting the Medicaid applications from the federal HealthCare.gov website to the state Medicaid program which led to delays in Medicaid beneficiaries receiving a determination of whether they were able to enroll in Medicaid.

General facts about New Jersey Medicaid:

Medicaid program name: Medicaid

CHIP Program name: NJ Family Care

Separate or combined CHIP: Combination

Medicaid Enrollment: 1.8 million (2018 estimate)

Total Medicaid Spending: $15 billion (FY 2017 estimate)

Share of total population covered by Medicaid: 17%

Share of Children covered by Medicaid: 33% (estimate)

Share of Medicaid that is Children and Adults: 79%

Share of Spending on Elderly and people with disabilities: 64%

Share of Nursing Facility Residents covered by Medicaid: 57% (estimate)

FMAP: 50%

Expansion state: Yes

Number of people in expansion: 563,000 (2018 estimate)

Work Requirement: No

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New Hampshire Medicaid History and Facts

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Initial Medicaid Implementation: New Hampshire began their Medicaid program in July of 1967. The state had run programs that helped people with limited incomes since the 1930s, prior to the implementation of the Social Security Act. The state had some issues with determining the correct payment rates and ensuring that there was little fraudulent payments, like many other states were experiencing at the time.

Key Medicaid Political Issues: New Hampshire, like other states in New England, has a low rate of uninsurance. New Hampshire extends CHIP coverage up to 300% of the poverty level, making it one of the most generous programs in terms of extending coverage to higher income families. The eligibility in these programs is divided into several levels of income eligibility and generosity of benefits. New Hampshire has a system that allows counties to contribute toward the cost of nursing facility services. New Hampshire has historically had high per-beneficiary spending, particularly for the aged, blind, and people with disabilities. Of that, the dual eligible population has driven a majority of those costs. After an attempt by the governor’s office to implement a waiver program that would move payments out of nursing facilities and into the home the legislature began requiring Medicaid waivers be approved by the legislature before submission. In recent years the focus of the Medicaid program has been on addressing the treatment of people with opioid dependency as the state has been on the forefront of the opioid epidemic.

 Medicaid Expansion Implementation: New Hampshire passed their Medicaid expansion in March of 2014. The state legislation required the governor to expand Medicaid using an 1115 waiver but allowed the state to expand through a state plan amendment while the 1115 waiver was being approved. This meant that enrollment for Medicaid expansion began in August of 2014 but the 1115 waiver was approved in November of 2014. Meaning that for a few months people enrolled in coverage without the stipulations of the waiver. The state governor flipped to being controlled by a Republican governor in 2016. In 2018 the state became the fourth state to have a work requirement plan approved by CMS. The plan is set to be implemented in January of 2019.

General facts about New Hampshire Medicaid:

Medicaid program name: Medicaid

CHIP Program name: Healthy Kids

Separate or combined CHIP: Medicaid Expansion

Medicaid Enrollment: 182,000 (2018 estimate)

Total Medicaid Spending: $2.1 billion (FY 2017 estimate)

Share of total population covered by Medicaid: 13% (estimate)

Share of Children covered by Medicaid: 33% (estimate)

Share of Medicaid that is Children and Adults: 80%

Share of Spending on Elderly and people with disabilities: 59%

Share of Nursing Facility Residents covered by Medicaid: 33% (estimate)

FMAP: 50%

Expansion state: Yes

Number of people in expansion: 54,000

Work Requirement: Yes (Beginning in January 2019)

Nevada Medicaid History and Facts

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Initial Medicaid Implementation: Nevada began their Medicaid program in July of 1967. The program was originally named SAMI (State Aid for the Medically Indigent). When the program began the state was initially running ahead of their budget despite the fact that categorical eligibility was limited compared to the experience in other states. When the program began, the state did not offer Medicaid coverage to the “medically indigent.”

Key Medicaid Political Issues: In the 1980’s Nevada established a County Match Program which gave counties matching dollars to serve certain populations. Under this program the county provides funding to the state in exchange for matching funds for services provided under the Medicaid program. The program is funded in part through provider taxes. In recent years the state has had a focus on mental health, applying for a waiver that would increase the amount private mental health care providers can bill by nearly double the previous levels. The state became the first to pass Medicaid Buy-In legislation through the legislature in 2017. The governor ultimately vetoed the policy.

Medicaid Expansion Implementation: Nevada expanded Medicaid as part of the Affordable Care Act with enrollment beginning in October of 2013 and coverage beginning in January of 2014. At the time, Nevada became the first state with a Republican governor to decide to expand under the Affordable Care Act. The state’s Medicaid expansion had been largely been quite until the 2017 Congressional repeal votes would end the expansion and block grant Medicaid. Then Governor Sandoval came to the defense of the Medicaid program.

General facts about Nevada Medicaid:

Medicaid program name: Medicaid

CHIP Program name: Nevada Check Up

Separate or combined CHIP: Combination

Medicaid Enrollment: 647,000 (2018 estimate)

Total Medicaid Spending: $3.56 billion (FY 2017 estimate)

Share of total population covered by Medicaid: 18% (estimate)

Share of Children covered by Medicaid: 33% (estimate)

Share of Medicaid that is Children and Adults: 80%

Share of Spending on Elderly and people with disabilities: 59%

Share of Nursing Facility Residents covered by Medicaid: 55%

FMAP: 64.87%

Expansion state: Yes

Number of people in expansion: 204,000 (2018 estimate)

Work Requirement: None

 

Nebraska Medicaid History and Facts

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Initial Medicaid Implementation: Nebraska began their state’s Medicaid program in July 1966 replacing the existing state programs that provided medical assistance. Nebraska was one of the first states to adopt Medicaid legislation following the passage in 1965. The state initially under budgeted for the Medicaid program implementation and had to request approximately $750,000 from the legislature to meet the demands in 1969.

Key Medicaid Political Issues: One provision of the Affordable Care Act required all states to extend coverage of foster kids through Medicaid up till the age of 26. The state struggled with implementing this provision of the law and faced criticism in the media and among advocates. The state began its managed care program in 1995 in the Eastern portion, or most populous portion, of the state. In 2010 the state expanded the program to seven additional counties. In 2013 the state transitioned behavior health services to a managed care contract statewide.

Medicaid Expansion Implementation: Nebraska held several votes on Medicaid expansion in the legislature and at one point had majority support to pass Medicaid expansion in the legislature but the bill failed because of the requirement to need 2/3rds of the legislature to pass. In November of 2018 Nebraska voters will vote whether to expand Medicaid through a proposition. The effort to put the proposition on the ballot faced a legal challenge from the state’s Republican leaders but was ultimately allowed to proceed by the courts. Prior to the expansion of Medicaid, the state did not cover childless adults at any level and covered parents up to 63% of the federal poverty level.

General facts about Nebraska Medicaid:

Medicaid program name: Medicaid

CHIP Program name: Kids Connection

Separate or combined CHIP: Combination

Medicaid Enrollment: 245,000 (2018 estimate)

Total Medicaid Spending: $2.1 billion (FY 2017 estimates)

Share of total population covered by Medicaid: 13%

Share of Children covered by Medicaid: 30% (estimate)

Share of Medicaid that is Children and Adults: 73%

Share of Spending on Elderly and people with disabilities: 69%

Share of Nursing Facility Residents covered by Medicaid: 50% (estimate)

FMAP: 52.58%

Expansion state: No

Number of people in expansion: N/A

Work Requirement: No

Montana Medicaid History and Facts

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Initial Medicaid Implementation: Prior to the implementation of the Medicaid program, Montana had a program that helped low-income seniors under the Kerr-Mills legislation. The plan was not generous and paid approximately 19 cents for medical care for every beneficiary on the program. Montana began their Medicaid program in July of 1967. When the program began, the state decided not to cover the “medically indigent” or the medically necessary population.

Key Medicaid Political Issues: The state has had several expansions of coverage outside of the ACA’s Medicaid expansion. The state enhanced provider payments and extended long-term care coverage while making the application process easier for beneficiaries in 2011-2012. Montana’s other main Medicaid issues have focused on issues related to the rural nature of the state.

Medicaid Expansion Implementation: Montana had rejected several attempts to expand Medicaid in 2013 ad 2014. The Democratic governor, Steve Bullock had long supported Medicaid expansion and proposed several policies that would have expanded either through a waiver or through the traditional expansion. A 2013 plan had bipartisan support in the legislature but failed to pass. In 2014 there was a campaign to get Medicaid expansion on the ballot through referendum but failed to collect enough signatures. Montana expanded Medicaid effective January 1, 2016. The state included a waiver that was approved by CMS in November of 2015. The waiver requires beneficiaries to pay a premium that is 2% of their income and enrollees that fail to pay their premium are barred from reenrolling for three months. The state included a sunset date in the original legislation of 2019 and whether the sunsetting of the legislation should continue is under debate in the 2018 elections. In November 2018, Montana will vote on continuing the Medicaid expansion with a change to the proposed revenue source. The state will vote whether to fund Medicaid expansion through an increase to the state’s cigarette tax.

General facts about Montana Medicaid:

Medicaid program name: Medicaid

CHIP Program name: Healthy Montana Kids (HMK) Plus

Separate or combined CHIP: Combination

Medicaid Enrollment: 279,000 (2018 estimate)

Total Medicaid Spending: $1.8 billion (FY 2017 estimates)

Share of total population covered by Medicaid: 22%

Share of Children covered by Medicaid: 44% (estimate)

Share of Medicaid that is Children and Adults: 71%

Share of Spending on Elderly and people with disabilities: 59%

Share of Nursing Facility Residents covered by Medicaid: 60% (estimate)

FMAP: 65.54%

Expansion state: Yes

Number of people in expansion: 58,000 (2018 estimate)

Work Requirement: No

Missouri Medicaid History and Facts

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Initial Medicaid Implementation: Prior to the implementation of the Medicaid program, Missouri ran a medical assistance program through the Kerr-Mills legislation. This program provided hospital and limited prescription drug and dental benefits. Medicaid was signed into law in Independence Missouri, home place of President Truman. Missouri began their Medicaid program in through the legislature’s adoption of Medicaid in October of 1967. When the program began, Missouri had no program for the medically indigent. The state did extend benefits to child welfare beneficiaries and blind people using state dollars prior to these categories of eligibility receiving federal Medicaid reimbursement.

Key Medicaid Political Issues: Although the Welfare reforms of 1996 ended the link between Medicaid and TANF, the state maintained many of the eligibility criteria for low-income residents through 2005. In 2005 the state eliminated the benefits for adults unless they met the minimum categories of pregnant of blind as defined by federal law. In 2007 the state passed a law requiring the program to be known as MO HealthNet in addition to Medicaid. The state in recent years has implemented several more regressive policies designed to make Medicaid coverage more difficult to obtain and maintain for beneficiaries. In 2016 the state enacted a law that would penalize Medicaid patients for missed appointments. The state has been at the center of the debate surrounding the defunding of Planned Parenthood.

Medicaid Expansion Implementation: Missouri has not expanded Medicaid. The state had a Democratic governor (Jay Nixon) and a Republican legislature for a large portion of the period that Medicaid expansion was being discussed. In 2014 the legislature debated a measure to expand Medicaid coverage. The Chamber of Commerce and local groups including a coalition of faith leaders have been active in supporting expansion and have supported plans to expand via referendum.

General facts about Missouri Medicaid:

Medicaid program name: Medicaid/MO HealthNet

CHIP Program name: MO HealthNet for Kids

Separate or combined CHIP: Combination

Medicaid Enrollment: 933,000 (2018 estimate)

Total Medicaid Spending: $10.2 billion (FY 2017 estimate)

Share of total population covered by Medicaid: 15%

Share of Children covered by Medicaid: 33% (estimate)

Share of Medicaid that is Children and Adults: 73%

Share of Spending on Elderly and people with disabilities: 70%

Share of Nursing Facility Residents covered by Medicaid: 66%

FMAP: 65.4%

Expansion state: No

Number of people in expansion: N/A

Work Requirement: No

Mississippi Medicaid History and Facts

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Initial Medicaid Implementation: Before Medicaid was passed, the state began a program for elderly low-income individuals through the Kerr-Mills program. The state started the program in 1964 only one year before the passage of Medicaid. Mississippi initially began their Medicaid program on January 1, 1970, the “deadline” to begin their Medicaid program, or the day the Kerr-Mills funding ended. The initial plan had modest benefits as Mississippi historically has had lower state funding and government oversight.

Key Medicaid Political Issues: Mississippi has a largely poor and rural population with a proportion of adults with high chronic diseases. The state receives the largest proportions of federal dollars (an FMAP of 74.17%) for the Medicaid program with the state only contributing 16 cents for every Medicaid dollar spent in the state. In 2011 the legislature authorized a program called MississippiCAN or the Coordinated Access Network which is the state’s managed care program. Approximately 65% of Medicaid beneficiaries participate in a MississippiCAN plan, lower than the national average. The program includes behavioral health services and covers individuals on Medicaid outside of the elderly and disabled populations. Prior to the establishment of the MississippiCAN program, managed care only covered 8% of beneficiaries.

Medicaid Expansion Implementation: Mississippi hasn’t expanded their Medicaid program. Following the coverage expansions of 2014 the state saw an enrollment growth of approximately 10% due to the welcome mat effect. In 2017 the state proposed a Medicaid work requirement to CMS for their parent and certain medically necessity adult populations. In 2017 Mississippi became the first state to receive a 10-year 1115 waiver that provides family planning services at higher income levels. The courts have prevented the state from barring Planned Parenthood from receiving these funds but challenges are ongoing.

General facts about Mississippi Medicaid:

Medicaid program name: Medicaid

CHIP Program name: CHIP

Separate or combined CHIP: Separate CHIP

Medicaid Enrollment: 640,000 (2018 estimate)

Total Medicaid Spending: $5.5 billion (FY 2017 estimate)

Share of total population covered by Medicaid: 24%

Share of Children covered by Medicaid: 50% (estimate)

Share of Medicaid that is Children and Adults: 65%

Share of Spending on Elderly and people with disabilities: 68%

Share of Nursing Facility Residents covered by Medicaid: 75%

FMAP: 76.39%

Expansion state: No

Number of people in expansion: N/A

Work Requirement: No* under review by CMS