Kansas Medicaid History and Facts

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Initial Medicaid Implementation: Kansas initially implemented their Medicaid program in 1967. In the early years of the Medicaid implementation, Kansas reported conditions of revoking medical licenses and reporting physicians for fraud because they received large sums of payment from the initial program’s implementation. Later providers were instructed by the state to limit the use of hospitalizations among Medicaid beneficiaries. Medicaid was administered at the county level until 1975 when the program was united under a new state agency, the Department of Social and Rehabilitation Services.

Key Medicaid Political Issues: In 2005 Kansas moved Medicaid into the newly created Health Policy Authority then again in 2011 the program was moved to the Department of Health and Environment. Kansas has maintained a modest Medicaid program. In recent years the state has taken reforms through an 1115 waiver under governor Brownback to move the program to managed care contracts. The waiver which transferred the existing population into the managed care KanCare program was under a great deal of scrutiny due to some business relationships between legislators and the managed care entities. Additionally, those receiving services through disability eligibility groups have reported significant access issues.

Medicaid Expansion Implementation: Kansas has wrestled with a shifting state government during the course of the Medicaid expansion debate. The state had moved to the far right under governor Brownback and made significant cuts in state funding of social services. The legislature has since moderated and in 2017 voted to expand Medicaid. The Governor ultimately vetoed the legislation and the current governor and GOP candidate have pledged to not expand Medicaid. It is possible that the state legislature could gain the votes to overrule a potential veto in the 2018 election. The state has proposed a work requirement as part of the renewal of its KanCare demonstration waiver. Since the state has yet to adopt the Medicaid expansion it is unclear whether the federal government would approve these changes for eligible adults with extreme circumstances and parents.

General facts about Kansas Medicaid:

Medicaid program name: Medicaid

CHIP Program name: Healthwave

Separate or combined CHIP: Separate CHIP

Medicaid Enrollment: 389,000 (estimate 2018)

Total Medicaid Spending: $3.27 billion (2017 estimate)

Share of total population covered by Medicaid: 14%

Share of Children covered by Medicaid: 29% (estimate)

Share of Medicaid that is Children and Adults: 71%

Share of Spending on Elderly and people with disabilities: 65%

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

FMAP: 57.1%

Expansion state: No

Number of people in expansion: NA

Work Requirement: No

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Iowa Medicaid History and Facts

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Initial Medicaid Implementation: Iowa began their Medicaid program in July of 1967, two years after the passage of the Medicaid program. The state did not participate in the Kerr-Mills program but began drafting a plan to participate in 1963. By then it was clear that Congress was looking to a new direction in providing health care services to states. Iowa would have become the 30th state to participate in the program.

Key Medicaid Political Issues: In recent years the focus of Iowa’s Medicaid program has been on transferring nearly all of the beneficiaries on Medicaid to managed care organizations. The transition plan was introduced in 2014 and implemented in 2016. The plan has been met with considerable political pressure and the Senate voted in 2016 to overturn the direction. It has continued to be a topic for a great deal of scrutiny as the transition to managed care has displaced and disrupted the care for many individuals.

 Medicaid Expansion Implementation: Iowa expanded Medicaid in 2014 due in part to the state receiving a waiver similar to the waivers received by Arkansas and Michigan who also expanded Medicaid at this time with a premium assistance waiver for individuals over 100% of the federal poverty level to purchase qualified health plans on the exchange. Uniquely to Iowa, the state decided to no longer participate in their waiver program in July of 2015. Instead the state would only implement the second waiver that they received when they decided to apply for Medicaid expansion funding and move beneficiaries into managed care organizations.

General facts about Iowa Medicaid:

Medicaid program name: Medicaid

CHIP Program name: Healthy and Well Kids in Iowa

Separate or combined CHIP: Combination

Medicaid Enrollment: 632,600 (2017)

Total Medicaid Spending: $4.8 billion

Share of total population covered by Medicaid: 17% (2015)

Share of Children covered by Medicaid: 40% (estimate)

Share of Medicaid that is Children and Adults: 80%

Share of Spending on Elderly and people with disabilities: 65%

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

FMAP: 56.7%

Expansion state: Yes

Number of people in expansion: 149,300

Work Requirement: No

Indiana Medicaid History and Facts

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Initial Medicaid Implementation: Indiana initially began their Medicaid program in January of 1970. The federal government had essentially set that date as the deadline for states to participate or else existing program funding would end. Indiana was one of several states that did not initially offer a program for the “medically indigent.”

Key Medicaid Political Issues: In 1991 the state consolidated services under the Family and Social Services Administration (FSSA) which contains the state’s SNAP program, disability, elderly, and child services programs in addition to Medicaid. The state has had a limited budget for mental health services that has put a strain on the state’s Medicaid program.

Medicaid Expansion Implementation: Then Indiana governor Mike Pence expanded Medicaid through a waiver in 2015. The program was branded HIP 2.0 named after the originally HIP program. Indiana had a program that covered a limited number of adults at the state’s regular matching rate. The state wanted to continue this program with the enhanced Medicaid expansion federal matching rate. CMS did not agree to this, requiring the state to enact Medicaid expansion to receive the enhanced match rate. The waiver that was eventually agreed to contains several provisions that limit enrollment and the use of medical services by beneficiaries. These include a lock-out period that prevents people from re-enrolling if they fail to pay their premiums, premiums that can be used as a health savings account, and co-payments and other cost sharing. There have been significant disagreements between the state and the federal government about how the state would collect data and evaluate the demonstration. In 2018 the state added work requirements and strengthen the lock out provisions of the program. As of August 2018 these provisions had not yet been implemented but plan to take effect in January of 2019.

General facts about Indiana Medicaid:

Medicaid program name: Medicaid

CHIP Program name: Hoosier Healthwise

Separate or combined CHIP: Combination

Medicaid Enrollment: 1.5 million (2017 estimate)

Total Medicaid Spending: $10.5 billion (FY 2016)

Share of total population covered by Medicaid: 19% (2015)

Share of Children covered by Medicaid: 40% (estimate)

Share of Medicaid that is Children and Adults: 75%

Share of Spending on Elderly and people with disabilities: 72%

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

FMAP: 66.7%

Expansion state: Yes

Number of people in expansion: 381,600 (2016)

Work Requirement: Yes