“It felt like this was a huge problem that many wanted to fix, and that we had to find a way to make it happen.”. Such post-ballot resistance prompted the Fairness Project to revise its strategy for its 2020 Medicaid campaign in Oklahoma. Will Medicaid expansion ballot initiatives pass in Oklahoma and Missouri. “One of the things we’ve learned is there is a huge benefit to building a long runway,” he said. Because laws allowing Medicaid expansion by public referendum are different, The Fairness project says at least six states could become targets … The Kentucky waiver that had been set aside by the courts has since been rescinded by the new Governor, and the case has now been dismissed. “They have modeling, they have research, they have a diverse coalition; we have that, too.”. Mike Parson, a Republican, opposes the ballot initiative and has argued that it will harm a state budget that is already under strain because of the pandemic. “People were frustrated,” said Chris Jennings, a longtime health care strategist who served in the Clinton and Obama administrations. In his memo, Regan proposed creating a nonprofit that would use the ballot initiative process to secure policies that would benefit workers, like increased access to health coverage and a higher minimum wage. “Even after the people pass it, they still fight it,” Morfeld said. Instead, the Nebraska-specific modifications to Medicaid expansion have come from Governor Ricketts’ administration. Parson, who opposes Medicaid expansion and is up for election this year, in May moved the vote on the proposal up from the Nov. 3 general election to Tuesday's primary. “I got in touch with the Fairness Project and basically asked: What would it take to have you come to Nebraska?” said state Sen. Adam Morfeld, who had spent years introducing legislation to create the program. Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions. It is the sixth state … After Nebraska voters approved a Medicaid expansion ballot measure in November 2018, the state delayed implementation until October 1, 2020 to allow time for the state to seek a Section 1115 waiver to implement expansion. A review of over 300 studies points to positive effects of expansion on coverage, access to care, service utilization, and state budgets and economies. Beyond work requirements, CMS has issued guidance and has been approving waivers to allow states to use Medicaid funds to provide short-term inpatient and residential treatment for enrollees with substance use disorder (SUD) and enrollees with serious mental illness (SMI) or serious emotional disturbance (SED) in institutions “institutions for mental disease” (IMDs). States are also working with their MCO and corrections partners to coordinate care for justice-involved individuals prior to release with the goal of improving continuity of care and smoothing community transitions. How will states and the federal government develop capacity and meet workforce and housing challenges to meet the needs of the growing elderly population? “Heritage Health Adult" (HHA) is the program name for Medicaid expansion. Millions of adults could gain Medicaid eligibility if additional states expanded their programs. Oklahoma is one of 14 states that continue to reject federal funding to expand Medicaid under the ACA. Some proposals would allow states to move current Medicaid enrollees to the public plan and some would require states to contribute to the costs through an MOE. A proposal to amend the state Constitution to expand eligibility for Medicaid is on Tuesday, Aug. 4, 2020s' ballot. As the need for Medicaid long-term services and supports is expected to rise as the population continues to age, states continue to expand the number of people served in home and community-based settings; however, direct care workforce and affordable housing shortages remain challenges in meeting the demands to serve the elderly and people with disabilities in community settings. Utah’s government added a provision that Medicaid enrollees had to work, volunteer or search for work to secure coverage, a restriction not in the original ballot. In many state capitals, hospitals have led the fight for Medicaid expansion either by lobbying lawmakers or bankrolling ballot initiatives. The Missouri Medicaid Expansion and Planned Parenthood Funding Initiative was on the ballot in Missouri as an initiated state statute on November 3, 2020. Samantha Artiga Follow @SArtiga2 on Twitter The petition to put a Medicaid expansion in Missouri to a statewide vote has garnered more than 25 percent of the needed signatures to place the measure on the November 2020 ballot… We need the grassroots infrastructure, and we need to disrupt the messaging and all that has been invested in attacking this policy.”, Donate to the newsroom now. , and Missouri Amendment 2, the Medicaid Expansion Initiative was on the ballot in Missouri as an initiated constitutional amendment on August 4, 2020. A review of over 300 studies points to positive effects of expansion on coverage, access to care, service utilization, and state budgets and economies. The Utah and Idaho measures were approved and later altered by the state legislatures. A number of states are also implementing payment policies to promote access to rural hospitals or other rural providers. As of January 2020, seven states had approved waivers with work requirements, ten states had pending waivers and three other states (Arkansas, Kentucky and New Hampshire) have had waivers set aside by the courts, citing the Secretary’s failure to consider the impact on Medicaid’s primary objective of providing affordable coverage. The ballot asked voters to approve a constitutional amendment, which could be altered only by another statewide referendum. Some states continue to seek approval for similar waivers. U.S. Coronavirus Cases (12/03): 14.140 million, Without the waivers, states have limited authority to finance these services for nonelderly adults in IMDs, reduced funds to support outreach and enrollment assistance, initiatives to improve birth outcomes and/or reduce maternal mortality. The next year, it returned to Maine to support the country’s first Medicaid expansion referendum. Despite ballot initiatives being adopted more than 18 months ago in Idaho, Nebraska, and Utah, some eligible residents in these states are still not covered. Published: Nov 02, 2020 To date, 39 states (including DC) have adopted the Medicaid expansion and 12 states have not adopted the expansion. The financial impact of Medicaid expansion is uncertain and could range from $200 million in extra costs to $1 billion in additional annual savings, according to an estimate prepared by the state’s auditor, Nicole Galloway, a Democrat who is running for governor in November. In addition, litigation challenging the ACA with support from the Trump administration is ongoing, with continued uncertainty about the law’s future. Fair Ballot Language: A “yes” vote will amend the Missouri Constitution to adopt Medicaid Expansion for persons 19 to 64 years old with an income level at or below 133% of the federal poverty level, as set forth in the Affordable Care Act. Many states are also implementing initiatives to improve birth outcomes and/or reduce maternal mortality. What Are Ballot Initiatives? States continue to expand the scope of services included in MCO contracts by carving in behavioral health and long-term care services into MCO contracts. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California. Will CMS issue guidance about block grant waivers and will the pending Tennessee waiver be approved? Medicare-for-all proposals would shift responsibility for designing and implementing much of health policy from states to the federal government and would generally eliminate current variation in eligibility, enrollment and renewal processes, benefits, and payment and delivery systems that are part of the current structure of Medicaid where states have considerable flexibility to design programs. Of the 12 remaining states that have not expanded Medicaid (excluding Missouri, where voters will decide Tuesday), only four have referendum processes: Florida, Mississippi, South Dakota and Wyoming. In November 2018, voters in Idaho, Montana, Nebraska, and Utah voted on ballot initiatives concerning Medicaid expansion and the funding of expanded Medicaid coverage. While some enrollees leaving Medicaid may have gained other coverage, survey data show a rise in the uninsured rate between 2017 and 2018, suggesting that some individuals losing Medicaid are becoming uninsured. And while the modifications are not as dr… The focus of Section 1115 waivers has changed over time reflecting changing priorities for states and CMS. Missouri Gov. The ballot asked voters to approve a … “It’s such a massive undertaking, but the number impacted would be the same as everywhere else combined, close to 800,000.”. Other states with approval have not yet implemented (Ohio, South Carolina, Utah, and Wisconsin) or have put the program on hold due to pending litigation (Arizona and Indiana). Missouri on Aug. 4 approved a Medicaid expansion ballot initiative, extending coverage to 217,000 low-income residents. Most Republican governors and legislatures had little interest in expanding the reach of the Affordable Care Act, and declined the money. Michigan is the only state currently implementing a work requirement waiver. The Fairness Project does not disclose a list of its donors, and declined to provide one to The New York Times (Schleifer did identify United Healthcare Workers West as the group’s “most significant” supporter). Florida, which has 2.7 million uninsured residents, is the Fairness Project’s next major focus. At the start of 2020, 37 states had adopted the ACA Medicaid expansion. “The way we ensure that we win is by running these campaigns like gubernatorial or Senate races,” said Jonathan Schleifer, a former congressional staffer who now leads the Fairness Project. In Ballot measures May 27, 2020 at 2:51 PM On May 22, 2020, the Missouri Secretary of State issued a statement certifying the Missouri Medicaid Expansion Initiative for the ballot. How will changes in the economy and the continued aging population affect Medicaid spending and enrollment trends in the future? Since the Governor continues to support expansion, the issue may come up again in 2020. This total includes Idaho and Utah, which implemented the expansion on January 1, 2020, and Nebraska, where the expansion was adopted but not yet implemented. In addition, North Carolina came close to passing the Medicaid expansion through the state legislature during the 2019 session, but ultimately failed to do so, adjourning the session without a budget. This total includes Idaho and Utah, which implemented the expansion on January 1, 2020, and Nebraska, where the expansion was adopted but not yet implemented. Two weeks ago, Oklahomans went to the polls and voted in favor of State Question 802, a ballot initiative to expand Medicaid. Not all states allow ballot initiatives. A ballot initiative is a form of direct democracy. But in June 2020, voters in Oklahoma passed a Medicaid expansion ballot initiative, paving the way for Medicaid expansion to take effect in Oklahoma by July 2021. As of January 2020, 27 states have approval for such waivers for SUD services, and two states have approval for SMI/SED services. How much flexibility will states be given under these block grant waivers? Missouri approves Medicaid expansion ballot initiative, extending coverage to 200,000 people Dylan Scott 8/5/2020 Federal Judge Blocks Texas Gov. But the initiative had enough support that the United Healthcare Workers West executive board approved its funding, and has continued to do so each year since. How prominent of a voting issue will health care be in the 2020 elections? The Fairness Project grew out of a memo that a California union leader wrote in 2014, warning that steep declines in union membership could leave workers unprotected with fewer benefits. While CMS has focused on increasing flexibility for states through waivers, some waiver requests have not been approved, including allowing for the ACA enhanced match for partial expansion (in Utah, Arkansas and Massachusetts), enrollment caps for the expansion group (in Utah) and closed prescription drug formularies (in Massachusetts). How will states continue to use managed care to help advance quality and constrain costs? How will changes in Medicaid coverage affect the number of uninsured? And then these guys came up with this referendum strategy.”. But they’re taking on hard issues in hard states, and they’re a lot more successful than some of us can say.”. A portion of Medicaid enrollment declines may reflect some states catching up on eligibility renewals after delays following implementation of new computer systems under the ACA. Idaho did not begin enrolling people in the new expansion group until November 2019, with coverage starting January 1, 2020. Before Oklahoma voted to expand Medicaid in July 2020, it had the second highest uninsured rates. Medicaid, the provider of health insurance coverage for about one in five Americans and the largest payer for long-term care services in the community and nursing homes, continues to be a key part of health policy debates at the federal and state level. While slower enrollment has moderated spending growth, rising costs for prescription drugs, provider rate increases, and costs for the elderly and people with disabilities (including increased utilization of long-term services and supports) are expected to put upward pressure on total Medicaid spending. After the initiatives pass, governors often delay, alter or outright refuse implementation. “They immediately did a poll in December 2017, and saw there was a path to victory.”. This qualified the initiative for the November ballot unless the governor called for it to go on the August ballot by the May 26 deadline. Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff. The group Florida Decides Healthcare initially aimed to have the Medicaid expansion measure appear on the 2020 ballot, but it failed to raise enough money after … Bolstered by a strong economy, an urgency to address the opioid and SUD crisis, and new options made available through the SUPPORT Act, many states are expanding Medicaid mental health/substance use disorder benefits, including medication-assisted treatment (MAT), and are using an array of pharmacy benefit management strategies to prevent opioid related harms. “We were left with either doing nothing or finding a new solution. While there are differences across all of the proposals and many lack sufficient details to fully understand the effects, these plans all could fundamentally change the broader health care system and would have significant implications for Medicaid and the role of states, an issue that has not received much attention. As mentioned earlier, initiatives are underway in Oklahoma and Missouri to put Medicaid expansion on the ballot in November 2020. The Fairness Project began in 2016, starting with ballot initiative campaigns for increasing the minimum wage in California and Maine. Published: Jan 17, 2020. Some questioned why dues paid in California would be spent running campaigns in the Midwest. The referendum passed in June. The program did not start enrolling members until the state elected a new governor, Janet Mills, a Democrat, in 2018. What will be the outcome of the election – at the presidential level, as well as in Congress and the states – and how will this affect Medicaid and broader health policy in 2021 and beyond? Five states have expanded Medicaid through ballot initiatives since President Donald Trump’s inauguration. Medicaid spending and enrollment trends not only reflect policy changes at the state and federal level but also reflect changes in the economy as well as demographic changes.

medicaid expansion ballot initiatives 2020

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