Are Nursing Homes Referring People to the Community? Information Bulletin # 380 (May, 2013) Several years ago, the disability and elder communities and the Centers for Medicare and Medicaid Services worked to revise the Minimum Data Set questionnaires. The MDS must be completed quarterly by each nursing home for each resident and then electronically submitted to CMS. The famous “Q1a” was the focus of the revisions that very much concerned the disability and elder communities. One of the primary goals was to change the system to help people transition to the community. Here are some national findings for the 1,322,697 people in nursing homes on 3/31/13. The following data is from what CMS collected from the nursing homes. 1. MDS Questions 100A-C report on the percentages of people in nursing homes who “Participated in the Assessment and Goal Setting”. Nationally, 84.48% of the residents participated. Nationally 31.73% of “family or significant others” participated, and 10.08% had a “guardian or legally authorized representative” participate. 2. MDS Questions 300A-B focus on “Residents’ Overall Expectation” and the “Goal Established During the Assessments.” The results show that nationally 27.63% of the residents “expect to be discharged to community.” That means 365,461 nursing home residents wanted to leave and expected to live in the community. While we do not have a breakdown, we know that residents themselves made up 62.27% of these respondents and another 30.23% were family or significant others. 3. Proceeding to question MDS 400A, nationally there were 84.85% of these 365,461 residents (that equals 310,093 people in nursing homes) had an “Active Discharge Plan” in place to return to the community. We have no idea why the 15.15% (55,367 people) did not have a plan since they wanted to leave the nursing homes and had an expectation they would leave. But when asked in MDS 400 B, “What determination was made by the resident and the care planning team regarding discharge to the community,” no data is provided. CMS writes “please be patient. This may take a few seconds to load.” It never loaded. It is not clear what “determination” had to be made for the 310,093 people who had an “active discharge plan.” Nor is it clear whether a nursing home “planning team” could trump a resident’s decision to move to the community. Are community advocates present when such a determination is made? Does the nursing home “planning team” have any knowledge of what community-based services could be provided? 4. When the MDS goes beyond the “Active Discharge Plan” stage, it asks if the “resident asked to return to the community?”(MDS 500 A). Again, no data was provided. Also, we do not understand why the resident, who had an “expectation” to return to the community (MDS 300 A/B) and who has an Active Discharge Plan, is then asked (how many times are necessary) if the resident asked to return to the community. What if a family member asks? 5. Here’s the real kicker. When the nursing homes completed the MDS 500 B question, the nursing homes concluded that 86.55% of the people had no “possibility of returning to community.” A death sentence imposed! The nursing home concluded that only 5.75% of the residents - remember, this is according to the nursing homes – had even a “possibility’ to return to the community. What services did the nursing homes think could not be provided in the community? 6. As appalling as these numbers are, the nursing homes are supposed to refer people to a “local contact agency” which is supposed to come into the nursing home and is supposed to provide assistance for the nursing home resident to transition back to their homes and apartments with appropriate home and community-based services. 7. And now for the final blow: only 2.5% of the nursing home residents were actually referred to a “local contact agency” as reported on MDS 500B. We assume (and hope) that these 2.5% are from those residents whom the nursing home thought there was a “possibility” to return to the community. Disability and Elderly Advocates: Based on the above data, it might be hard to imagine but people in nursing homes are Not Dead Yet! What are advocates doing to help disabled and elderly in nursing homes move back into the communities? 1. Here is a link for the MDS data which is available by State. http://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/Minimum-Data-Set-3-0-Public-Reports/Minimum-Data-Set-3-0-Frequency-Report.html 2. There are a limited number of prizes for advocates who know the name of your “local contact agency.” There are more prizes for the local contact agency that has received the most such referrals. These prizes are time-limited so please send in your responses as soon as possible. 3. Can anyone explain why CMS’ nursing home office of “Surveys and Certifications” does not check on any of the above MDS questions? Is there any doubt that if CMS included these MDS questions in its annual surveys the percentages of people who wanted to leave would increase? Maybe even more people would transition back to the communities. 4. There is a very special prize for the advocates who can identify any person in a nursing home who could not reside and be cared for in the community with appropriate services. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.

“Premium Assistance,” People with Disabilities, and Medicaid Expansion Via Insurance Exchanges. Information Bulletin #379 (4/2013) Do you reside in a State that has not agreed to expand Medicaid under the Affordable Care Act (ACA) to all persons whose incomes are under 138% of the federal poverty level? Has your Governor talked about using Medicaid’s “premium assistance” plan to purchase a health plan via an “Exchange” for people under 138% – the “Arkansas model”? This Information Bulletin attempts to clarify some of these concepts, particularly as they apply to people with disabilities. 1.The normal way most States are implementing the ACA Medicaid expansion is to provide all persons with incomes under 138% with defined Medicaid benefits delivered through one Medicaid system. The “Arkansas model” is different and is the outlier. It uses Medicaid funds as “premium assistance” payments with which a State will purchase a private health plan, through the health insurance exchange being created for each state under the ACA (run either by the state or by the federal government). This private health plan will be limited to specific covered health benefits and services. Based on the proposed federal regulations and guidance from the federal Medicaid agency, CMS, the additional benefits covered under Medicaid, and the cost-sharing protections under Medicaid, must still be provided, these are likely to be very difficult to access. However, absent a special waiver, with premium assistance payments, a State cannot mandate that anyone under 138% receive Medicaid expansion services via the private insurance market; they must all be offered the choice of traditional Medicaid. 2. There is one possible way your State may try to get around this prohibition on mandatory enrollment in premium assistance. The State may apply to CMS for a section 1115 demonstration waiver to provide premium assistance to purchase a health plan on an Exchange and to make participation mandatory. What is critical for people with disabilities to know is that, under such a waiver, “A State may not require an individual to obtain [Medicaid services and health care] benefits through enrollment” with premium assistance payments if the person fits into one of the following five categories. If you are in one of these categories, the State cannot force you into a private health plan even through a 1115 waiver. Instead, the State must provide the traditional Medicaid benefits and services that current Medicaid recipients who are disabled are eligible for and receive, and deliver them in the traditional manner. The exempted categories are: 1. Blind and disabled persons (or persons “being treated as being blind or disabled) without regard to whether the individual is eligible for supplemental security income benefits …on the basis of being blind or disable. Nationally, we estimated that 2,665,407 people with disabilities are in this category. See Information Bulletin #369 (1/2013) or http://stevegoldada.blogspot.com/ for a State-by-State breakdown. 2. Dual eligibles – i.e., persons who receive both Social Security disability and Supplemental Security Income benefits. 3. Persons institutionalized in a “nursing home, an intermediate care facility for the mentally retarded, or other medical institution, and required, as a condition of receiving services in such institution under the State plan, to spend for costs of medical care all but a minimal amount of the individual’s income required for personal needs.” 4. “Medically frail and special medical needs individuals,” (as identified in accordance with regulations of the Secretary). 5. Persons who qualify for long-term care services. “The individual qualifies based on medical condition for medical assistance for long-term care services,” including Home and community-based services furnished under a 1915 waiver. These exempted categories are critical. These people are entitled to all of the Medicaid services and benefits currently available to existing Medicaid recipients who are disabled, through the existing delivery system. 3. Do you reside in a State that is considering using premium assistance payments for people on Medicaid? If you do, please make sure your State is fully aware that it will have to run two separate programs for the Medicaid 138% expansion population, even with a waiver allowing it to force some Medicaid enrollees into premium assistance. One Medicaid program will provide all the components in the State’s existing benefits and services for people in categories ## 1 -5 above, and for others who opt out of premium assistance if there is no waiver. A second and separate Medicaid expansion program will use premium assistance payments for people not exempted under a waiver, or who have not opted out if there is no waiver. We expect that most States using premium assistance without a waiver will try to convince people in categories ## 1-5 to receive services through private insurance in the Exchange paid with the premium assistance. Don’t do it! You are exempted from mandatory enrollment. Why are we so emphatic? There is no way a private insurance company that is paid to provide “Exchange” health services will provide the long-term care Medicaid services that people in categories ##1-5 need to live independent, integrated lives in their homes and apartments. Congress did not even require Exchanges to include long-term care services or benefits, and you can bet they will not. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.

What are the Religious Communities doing in your State Re Medicaid Expansion? Information Bulletin # 377 (4/2013) Have the various religious communities in your State taken a public position with regards to Medicaid expansion for residents whose incomes are less than 138% of the federal poverty level? Last week in Pennsylvania, 1,350 Roman Catholic nuns, priests, and brothers, representing 19 different religious congregations, were individually identified, by name and religious affiliation, in a letter written to the Pennsylvania Governor in which they urged him to accept federal Medicaid funds to expand coverage to nearly 700,000 residents who lack coverage. These religious leaders noted that their “faith, tradition and justice teaching call us to advocate for the right of all human beings to have access to the basic necessities that enable them to live productive lives with dignity. Among those is the right to affordable health care.” They stated that a failure to accept these funds by the Governor would “breach the moral duty to those who are on the margins of society.” They requested a meeting with the Governor. These leaders pointed out the health benefits, cost savings on uncompensated care to hospitals, and economic stimulus which will occur with the Medicaid expansion. These religious leaders concluded that their “faith calls us to respond to the needs of the disabled, the impoverished, and the downtrodden. The Medicaid expansion is an unparalleled opportunity to provide affordable health insurance for uninsured Pennsylvanians.” In every State there are coalitions of religious congregations – Protestant, Evangelical, Jewish, Catholic, and others. Have they taken a public position regarding Medicaid expansion? Have they written to the Governor and state legislators? Have you asked them to? What have they done in North Carolina, South Carolina, Georgia, Alabama, Mississippi, Texas, Oklahoma, Nebraska, Iowa, Tennessee, Virginia, West Virginia, Kansas and Utah? Surely there are religious leaders and coalitions who recognize Medicaid expansion as a “moral duty.” Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.

One Strategy to Increase Monthly Income for Disabled Persons – Corrected!!!!!!. Information Bulletin #376A (3/2013) [Introduction – I apologize. In the above Information Bulletin, I made an error that a few people pointed out to me. The correction below regarding Medicare and Medicaid will significantly benefit people who apply, so I am rewriting this Bulletin with the corrections and thank all of you who pointed out my error. On a personal note, it is really gratifying that people actually read the Information Bulletin to the end. I must admit that I am never confident how many people read these, or do they float away in outer space. Thanks. Steve] There are more than 7 million persons who are disabled and who receive Supplemental Security Income because they have a disability. This Information Bulletin is addressed to a subset those 7 million -- whose disability began before they were 22 years old and whose parents receive or were entitled to receive Social Security retirement benefits. This Information Bulletin is to remind and or inform this subset of 7 million SSI recipients of a potential federal financial benefit that could increase their monthly incomes. This subset of 7 million disabled persons’ living arrangements differ: some live independently on their own; some live in group homes or with roommates; some are married and live with their spouses; and some still reside with their aging nondisabled parents. Some have physical disabilities, some intellectual and some mental disabilities. Some were born with their disability and some acquired their disability before age 22. If you are one of these 7 million or know people who are, you and they might be eligible to receive “Child’s benefits” – under the Social Security retirement system - based on the “earning record of an insured person,” your parent(s) Social Security retirement benefits, whether or not your parents are still alive. What this means in nontechnical terms is: 1.Is either parent receiving Social Security retirement benefits, Social Security Disability benefits, or has either parent died? If one of your parents has died, you may be eligible to receive benefits on his/her account if s/he had a history of working. 2.Don’t be misled by the term “child.” It does not mean your age, but refers to your relationship to your parent. For example, a 45 year old recipient of SSI has a 67 year old parent who collects S.S. retirement benefits. The 45 year old may be entitled to “child’s benefits” based on his parent’s earning record. 3.Did your disability begin before you were 22 years old? Here is concrete example of how this system works. A.You became disabled before you were 22 years old. This could have been at birth or any time before you were 22. B.You receive SSI (although that is not a requirement). It does not matter where you reside or with whom you reside. C.What is important is that one of your parents receives Social Security retirement benefits (a/k/a Social Security “Old-Age” benefits), Social Security Disability Benefits, or if either parent has died and that parent had a work history that would have qualified him/her for Social Security retirement benefits. The dollar difference between your SSI monthly benefits and the “child’s benefits” based on your parents earning record could be significant. You may receive up to one-half of your parent’s full retirement benefit or disability benefit while your parent is still alive, and up to 75 percent of your parent’s Social Security benefit when s/he dies. You must apply to the Social Security Administration, which can be done in person, or by telephone or on-line. It is worth your effort to find out the monthly benefits you may be entitled to, whether or not you decide to actually apply, and compare that sum with your SSI. Two additional points: 1.Normally “child’s benefits” end if the person marries. However, if a person with a disability marries another disabled person who receives disability benefits, then you are still eligible for “child’s benefits.” 2. A big issue is health care coverage and benefits. On SSI, you receive Medicaid. In many States – not all – if your “child’s benefits” are less than 138% of the federal poverty level ($1,285 a month), you will still be Medicaid eligible effective 1/2014. In many States, you can become eligible for Medicaid under “spend down” requirements. If you start to receive your parent’s social security benefits because of your disability began before you were 22, you will also be eligible for Medicare benefits after you have been eligible for your parent’s benefits for 24 months. Check out how this issue will specifically apply to you. Also, in 1987, a federal law was enacted that says that if you are receiving Medicaid (maybe because you receive SSI on your own account), and then you start to receive Social Security benefits from a parent’s account, the amount of your parent’s benefit will not be considered when your State is deciding if you are financially eligible for Medicaid. For example, let’s say you are receiving $715 a month of SSI and also have Medicaid. Then your father dies and you become eligible for $1,000 a month in Social Security on your father’s account. Your State cannot count any of the $1,000 a month from your father’s Social Security when deciding if you are eligible for Medicaid. Here is the citation, 42 U.S.C. § 1383c, or http://www.ssa.gov/OP_Home/ssact/title16b/1634.htm (Determination of Medicaid Eligibility). Is the Social Security Administration motivated to provide the maximum amount of income to which people with disabilities are entitled to receive? The SSA knows each of the 7 million SSI recipients, their age when they became disabled and their parents’ status. It cannot be too difficult to at least notify them of these potential rights. In fact the Social Security Administration requires that you apply for benefits on your parent’s account if there is a chance you might be eligible, in part because SSI is a “payment of last resort.” There are a number of wrinkles which this Information Bulletin does not discuss. Telephone the Social Security 800 number and make an application. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.

One Strategy to Increase Monthly Income for Disabled Persons. Information Bulletin #376 (3/2013) There are more than 7 million persons who are disabled and who receive Supplemental Security Income because they have a disability. This Information Bulletin is addressed to a subset those 7 million -- whose disability began before they were 22 years old and whose parents receive or were entitled to receive Social Security retirement benefits. This Information Bulletin is to remind and or inform this subset of 7 million SSI recipients of a potential federal financial benefit that could increase their monthly incomes. This subset of 7 million disabled persons’ living arrangements differ: some live independently on their own; some live in group homes or with roommates; some are married and live with their spouses; and some still reside with their aging nondisabled parents. Some have physical disabilities, some intellectual and some mental disabilities. Some were born with their disability and some acquired their disability before age 22. If you are one of these 7 million or know people who are, you and they might be eligible to receive “Child’s benefits” – under the Social Security retirement system - based on the “earning record of an insured person,” your parent(s) Social Security retirement benefits, whether or not your parents are still alive. What this means in nontechnical terms is: 1.Is either parent receiving Social Security retirement benefits or either parent died but would have been eligible to receive those benefits? 2.Don’t be misled by the term “child.” It does not mean your age, but refers to your relationship to your parent. For example, a 45 year old recipient of SSI has a 67 year old parent who collects S.S. retirement benefits. The 45 year old may be entitled to “child’s benefits” based on his parent’s earning record. 3.Did your disability begin before you were 22 years old? Here is concrete example of how this system works. A.You were became disabled before you were 22 years old. This could have been at birth or any time before you were 22. B.You receive SSI (although that is not a requirement). It does not matter where you reside or with whom you reside. C.What is important is that one of your parents receives Social Security “Old-Age” insurance benefits, a/k/a Social Security retirement benefits, or either parent received those benefits before s/he died and would have been eligible for them now, were your parent alive. The dollar difference between your SSI monthly benefits and the “child’s benefits” based on your parents earning record could be significant. You may receive up to one-half of your parent’s full retirement benefit, or 75 percent of the deceased parent’s basic Social Security benefit. You must apply to the Social Security Administration, which can be done by telephone or on-line. It is worth your effort to find out the monthly benefits you may be entitled to, whether or not you decide to actually apply, and compare that sum with your SSI. Two additional points: 1.Normally “child’s benefits” end if the person marries. However, if a person with a disability marries another disabled person who receives disability benefits, then you are still eligible for “child’s benefits.” 2. A big issue is health care coverage and benefits. On SSI, you receive Medicaid. In many States – not all – if your “child’s benefits” are less than 138% of the federal poverty level ($1,285 a month), you will still be Medicaid eligible effective 1/2014. In many States, you can become eligible for Medicaid under “spend down” requirements. Unfortunately, you are not eligible for Medicare benefits based on your parent’s earning record. Check out this issue as it will specifically apply to you. Is the Social Security Administration motivated to provide the maximum amount of income to which people with disabilities are entitled to receive? The SSA knows each of the 7 million SSI recipients, their age when they became disabled and their parents’ status. It cannot be too difficult to at least notify them of these potential rights. There are a number of wrinkles which this Information Bulletin does not discuss. Telephone the Social Security 800 number and make an application. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.

Why Private Employers Should Support Medicaid Expansion. Information Bulletin #375 (3/2013) Medicaid expansion is obviously critical for people whose incomes are less than 138% of the federal poverty level. However, the failure of States to expand their Medicaid program on January 1, 2014 will have disastrous impact on the private employers in your State. The Missouri Hospital Association recently released a report entitled “The Hidden Health Care Tax – How NOT Reforming Medicaid Could Lead to Cost Shifting.” www.missourihealthmatters.com/wp-content/…/Cost-Shift_Report.pdf This report presents data and arguments regarding how private employers will be negatively impacted if a State does not expand Medicaid and presents cogent arguments for advocates to use in urging Governors and State Legislatures to agree to Medicaid expansion. As you know from previous Information Bulletins, when Congress enacted the Affordable Care Act it significantly reduced the reimbursements that hospitals previously received uncompensated care the hospitals had been providing to low-income people. This reduction was because Congress had simultaneously mandated Medicaid expansion to all people who had been receiving this uncompensated care. With such expansion, the hospitals would receive regular Medicaid reimbursement for the newly Medicaid eligible people. Unfortunately, the Supreme Court invalidated the mandatory expansion, leaving States, hospitals and insurance companies with significant reductions in uncompensated care and no increase in Medicaid eligible persons. It has been reported that the growth of “uncompensated care is alarming,” from 2002 to 2011. Every State that does not expand its Medicaid program will suffer because the hospitals will continue to have high level of uncompensated care and no Medicaid dollars with which to pay for that care. Uninsured and uncompensated care account for a significant amount of costs hospitals must make up through other means. How will hospitals make up the lost Medicaid costs? Private commercial insurance payers will eventually (sooner than later) have to subsidize the cost of the loss in Medicaid reimbursements. The costs will be shifted from the loss of Medicaid patients to the private businesses that currently provide health insurance to their workers. This will happen regardless of their employees’ incomes. The above “The Hidden Health Care Tax” report presents the data quite starkly. The shifting of costs from uninsured/nonMedicaid low-income patients to employers of low-income workers are “hidden health care taxes” on commercial premiums and will increase what private employers will pay for the private health insurance of their employees. Otherwise, the hospitals will not be able to financially survive. Advocates: Has your State Hospital Association estimated the increase in costs to private employers’ health insurance premiums if your State does not expand Medicaid? Has your State Hospital Association publicly stated this increase? Has your Chamber of Commerce estimated this cost and the impact it will have on private employers’ insurance premiums? Are your Governors and legislatures aware of this ramification and increased costs if they refuse to accept 100% of federally reimbursed Medicaid expansion funds? Are your newspapers aware of these increased costs? Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.comor call 215-627-7100. Ext 227.

Florida Opts Into Medicaid Expansion, Religious Leader, and 10 Year Data. Information Bulletin #373 (2/2013) This Information Bulletin deals with three aspects of the Medicaid expansion struggle: 1. Florida, 2. Religious leaders, and 3. Ten year data. 1.Another Republican Governor has announced his State will provide Medicaid services beginning January 2014 to all of its citizens with incomes under 138% of the federal poverty level. What should be a clear non-partisan issue, health care for the poorest people in a state, has unfortunately morphed into party politics. That’s one reason it is important that Florida’s Governor Rick Scott joined Republican Governors in Michigan, Ohio, Nevada, New Mexico, North Dakota and Arizona. Governor Scott had said quite emphatically that “Florida would not expand its program.” Why the reversal? What makes Governor Scott’s announcement particularly important is that he understood two points that many non-participating Governors apparently have ignored. First, Governor Scott said that “our options are either having Floridians pay to fund [Medicaid expansion] in other states while denying health care to our citizens or using federal funding to help some of the poorest in our state.” NYT, 2/20/13. Yes, if your State does not opt-in, your State’s taxpayers will be paying for health care for low-income people in participating States that have agreed to the Medicaid expansion. That’s neither a very smart business decision nor a sound policy decision. Second, “since Florida is legally allowed to opt out [of Medicaid expansion in the future], that’s the right decision for our citizens.” Yes, CMS has stated that a State that provides Medicaid expansion services can at any time decide to end its participation and there are no repercussions. Have you contacted your Governor? Will other Governors see the importance of these two points for their States? Will advocates follow the Florida advocates’ success? 2. Religious leaders are realizing the moral implications in Medicaid expansion. For example, the “Roman Catholic bishops of Salt Lake City and Little Rock, Ark., have urged state officials to expand Medicaid. “ NYT, 222/13. Sorry to add another item to your plates, but have you contacted religious leaders in your State? Are they doing anything to encourage recalcitrant elected officials to do the right and smart thing? 3. A separate third Medicaid expansion issue. In previous Information Bulletins and individual State Fact Sheets, we have provided (thanks to the Kaiser Commission) six year out data from 2014 through 2019 to show the amount of federal funds would be received by Medicaid expansion and the amount of money a State would have to spend as a match over the six years. A number of States are now arguing a longer time-frame, and they are suggesting/implying that over a longer than six years the federal funds may not be worth receiving. Therefore, we will provide for a period through 2022 (again thanks to Kaiser Commission) data for those states that have still not opted in to the Medicaid expansion. The results are the same as for six years. States make out like bandits!!!!! No business person in her or his right mind would turn down accepting the federal funds for the amount they must match over a ten year period. It makes no business sense. Isn’t it time that politics be put aside and rational business decisions take over? INCREMENTAL IMPACT OF MEDICAID EXPANSION 2013-2022 Federal funds and state matches over 10 years. Alabama $14,371 billion of federal funds with only a $1,081 billion Alabama state match. Alaska $1,458 billion of federal funds with only a $147 million Alaska state match. Arkansas $12,465 billion of federal funds with only a $922 million Arkansas state match. Georgia 33,711 billion of federal funds with only a $2,541 billion Georgia state match. Idaho $3,280 billion of federal funds with only a $246 million Idaho state match. Indiana $17,322 billion of federal funds with only a $1,099 billion In Diana state match. Iowa $3,909 billion of federal funds AND a $534 savings in Iowa state funds!!!!! Kansas $5,270 billion of federal funds with only a $524 million Kansas state match. Kentucky $17,832 billion of federal funds with only a $1,297 billion Kentucky state match. Louisiana $15,786 billion of federal funds with only a $1,244 billion Louisiana state match. Maine $3,124 billion of federal funds AND a $570 million savings in Maine state funds!!!. Mississippi $14,499 billion of federal funds with only a $1,048 billion Mississippi state match. Missouri $17,795 billion of federal funds with only a $1,573 billion Missouri state match. Nebraska $3,063 billion of federal funds with only a $250 million Nebraska state match. New Jersey $15,366 billion of federal funds with only a $1,492 billion New Jersey state match. North Carolina $39,638 billion of federal funds with only a $3,075 billion North Carolina state match. Oklahoma $8,561 billion of federal funds with only a $689 million Oklahoma state match. Pennsylvania $37,842 billion of federal funds with only a $2,842 billion Pennsylvania state match. Rhode Island $2,935 billion of federal funds with only a $250 million Rhode Island state match. South Carolina $15,827 billion of federal funds with only a $1,155 billion South Carolina state match. Soth Dakota $2,110 billion of federal funds with only a $157 million South Dakota state match. Tennessee $22,541 billion of federal funds with only a $1,715 billion Tennessee state match. Texas $65,619 billion of federal funds with only a $5,669 billion Texas state match. Utah $5,274 billion of federal funds with only a $364 million Utah state match. Virginia $14,665 billion of federal funds with only a $1,326 billion Virginia state match. West Virginia $8,744 billion of federal funds with only a $619 million West Virginia state match. Wisconsin $12,263 billion of federal funds AND a $248 million savings in Wisconsin state match!!!! Wyoming $1,353 billion of federal funds with only a $118 million Wyoming state match. Ten year data from Kaiser Commission, “The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis,” at Table 6 (November, 2012). Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. Information Bulletins will also be posted on my blog located at http://stevegoldada.blogspot.com/ To contact Steve Gold directly, write to stevegoldada1@gmail.com or call 215-627-7100. Ext 227.