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

 

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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

Minnesota Medicaid History and Facts

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Initial Medicaid Implementation: Prior to the implementation of the Medicaid program, Minnesota ran a Kerr-Mills program that together with 4 other states took nearly 2/3rds of the funds for the nationwide program. The program unlike many other states provided comprehensive medical benefits. Minnesota initially began its Medicaid program in January of 1966, the first opportunity that the state had to implement Medicaid. When the program began it was estimated that 5% of the population was eligible for Medicaid. Again, the benefits offered were comprehensive with Minnesota being one of five states to offer all services to which the federal government would reimburse.

Key Medicaid Political Issues: Minnesota has made several efforts to integrate delivery system reforms and efforts to integrate social determinants of health into their Medicaid program. In 1983 the state began a program named PMAP that provided payments to HMOs particularly for rural areas. These nonprofit HMOs provided health care services to low-income residents at higher eligibility rates than the national average under the Medicaid program prior to the expansion of coverage. Today, approximately 750,000 Minnesota residents receive services through the PMAP program. Minnesota has generous optional benefits available to all residents including coverage of doula services and vision and dental benefits that are more generously available.

Medicaid Expansion Implementation: Minnesota expanded Medicaid with coverage beginning on January 1st, 2014 and enrollment beginning in October of 2013. Minnesota ran their own exchange which made integration with their Medicaid program more seamless than states that used the federal infrastructure. The state runs a Basic Health Program which provides an insurance option to people making under 200% FPL. The Governor proposed a plan that would add a Medicaid Buy In program to the state’s Medicaid expansion and basic health programs. The program did not gain traction in the legislature. In 2018 members of the Minnesota legislature proposed adding work requirements for the expansion population, however that proposal did not gain traction in the legislature.

General facts about Minnesota Medicaid:

Medicaid program name: Medical Assistance (Medicaid)

CHIP Program name: MinnesotaCare

Separate or combined CHIP: Combination

Medicaid Enrollment: 1.07 million

Total Medicaid Spending: $11.5 billion (FY2017 estimate)

Share of total population covered by Medicaid: 14%

Share of Children covered by Medicaid: 25% (estimate)

Share of Medicaid that is Children and Adults: 80%

Share of Spending on Elderly and people with disabilities: 58%

Share of Nursing Facility Residents covered by Medicaid: 50%

FMAP: 50%

Expansion state: Yes

Number of people in expansion: 223,000 (2018)

Work Requirement: No

Michigan Medicaid History and Facts

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Initial Medicaid Implementation: Michigan was crucial to the initial passage of the Medicaid and Medicare law. It was at University of Michigan where President Johnson gave his Great Society speech in 1964 and Michigan Senator McNamara was in opposition of early Medicare and Medicaid legislation because he opposed to cost sharing or any income test in Medicare. Michigan began their Medicaid program in October of 1966. When the program began it was estimated that 4 percent of the states residents enrolled in Medicaid coverage. By 1967 Michigan’s Medicaid program was already running fiscal deficits and substantial payments were being made to non-welfare cases because the eligibility levels were well above welfare eligibility levels. Michigan began to be concerned with fraud and high payment rates of physicians finding that one physician was paid as much as $169,000 from the Medicaid program.

Key Medicaid Political Issues: Michigan has delivered services through HMOs since the early 1970’s. In 1997 the state fully privatized the system, including the disabled population. The state was an early adopter in providing services through a HMO to disabled individuals. Through the late 2000’s and early 2010’s the state continued to make MCO enrollment mandatory for special eligibility groups including dual eligible through the CMMI demonstrations.

Medicaid Expansion Implementation: Michigan expanded their Medicaid program in 2013 with benefits beginning on April 1, 2014. The Centers for Medicare and Medicaid Services (CMS) approved a waiver for Michigan’s Medicaid expansion alternative plan on December 30, 2013. This plan, known as the Healthy Michigan plan used the premium assistance program similar to Arkansas and Iowa’s waiver applications, premiums and additional cost sharing, and certain wellness program benefits that can reduce medical expenditures for the beneficiary if the person participates in a wellness program. In 2017 the state legislature voted to approve a plan that would add work requirements to the Medicaid expansion program. The plan was widely critiqued for exempting certain predominately white counties while subjecting urban predominately African American counties to the requirement. The legislature decided not to include this policy in the final bill that was approved by the legislature. The work requirement waiver is currently under review with CMS. Aside from the addition of work requirements, the state’s 1115 waiver ends the premium assistance program

General facts about Michigan Medicaid:

Medicaid program name: Medicaid

CHIP Program name: MICHIP

Separate or combined CHIP: Combination

Medicaid Enrollment: 2.3 million (2018 estimate)

Total Medicaid Spending: $16.8 billion (FY 2017 estimate)

Share of total population covered by Medicaid: 22%

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

Share of Medicaid that is Children and Adults: 78%

Share of Spending on Elderly and people with disabilities: 62%

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

FMAP: 64.45%

Expansion state: Yes

Number of people in expansion: 637,000 (2017 estimate)

Work Requirement: No* under consideration by CMS