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.

If Texas can organize to expand Medicaid, what about your State? Information Bulletin # 372 (2/2013) Like many Governors, Texas’ Rick Perry has not committed to expand Medicaid for low-income people whose incomes are under 138% of the federal poverty level. However, Texas advocates have been doing their homework and are organizing the Trade Associations to explain to their Governor and elected officials why it’s essential that Texas agrees to Medicaid expansion. What follows is an excerpt from a newspaper article that explains what’s happening in Texas. These same arguments in this article are applicable in every State that is still sitting on the fence. You have to get to your Trade Associations and form a coalition. Trade Associations Lend Support for Medicaid Expansion by Becca Aaronson, February 5, 2013, in The Texas Tribune. “Despite the resistance of Gov. Rick Perry and many other Republicans to expanding Medicaid in Texas under the Affordable Care Act, some momentum seems to be building from outside of the Capitol in support of the expansion. “Texas’ two largest health care trade associations, the Texas Medical Association and the Texas Hospital Association, have announced support for extending Medicaid coverage to low-income adults. But both organizations also say that in order for the plan to work in Texas, lawmakers here also must implement reforms that will contain costs and bring more doctors into the Medicaid program to provide care for the additional patients. “ ‘The most viable path is to try to work with [the federal government] to create a reformed program that does meet the needs of Texas better,’ said John Hawkins, senior vice president of government relations at the Texas Hospital Association. He said the plan to expand must be bipartisan. Democrats must be flexible in considering “personal responsibility” reforms, such as requiring some new patients under the expansion to pay co-pays. And Republicans, he said, must “play ball” because the current system is fiscally inefficient. “We’re still providing this care at the local government level, but we’re doing it in a fragmented way that actually costs more and has worse outcomes,” Hawkins said. For an additional investment of $15 billion over 10 years, Texas could draw down $100 billion in federal funding to insure two million more Texans through the state’s Medicaid program, according to a report by Billy Hamilton, a nonpartisan consultant who was previously the state’s chief revenue estimator. [We can provide a 10 year comparison for your State. Just email me below and tell me what State.] The Texas Medical Association, which represents physicians across the state, announced on Saturday that it would support the Medicaid expansion if lawmakers can devise a way to give Texas “the flexibility to change the plan as our needs and circumstances change.” “You have the two major entities that represent the delivery of health care in Texas saying this is something that we definitely need to look at,” said Dr. Carlos Cardenas, vice president of the TMA board of trustees, adding the organization recognizes “there are issues within the present Medicaid program and that the Legislature is in a position to come up with some reforms to shore up the system.” *** Perry, who has the power to veto an expansion plan approved by the Legislature, also reiterated in his state of the state address in January that Texas would not expand Medicaid. “Gov. Perry continues to believe that Medicaid is an unsustainable, broken program that needs to be reformed, and he does not support expanding it under Obamacare,” spokesman Josh Haven said in an email. *** “The more people and organizations that come on board, the more likely there is to be a strings-attached proposition for the Medicaid expansion,” said state Rep. Garnet Coleman, D-Houston. As a proponent of expanding Medicaid coverage, Coleman said he would accept some reforms offered by Republicans, such as co-pays for expansion enrollees. “It’s hard to turn down $100 billion, so the question is what can be agreed upon to accept the $100 billion. And we have not gotten there yet.” To work around Perry’s veto power, state Sen. Rodney Ellis, D-Houston, has proposed a constitutional amendment that would allow Texas voters to decide whether to expand Medicaid. “There is a lot of political posturing going on, but the bottom line is that it makes no sense to reject additional federal health aid,” Ellis said in an email. “I believe we do millions of Texans a disservice — at a real financial and human cost — if we dither and delay implementing this common sense reform.” Whether Medicaid expansion happens in your State is up to you. Sure, it is not easy, but its doable and its critically important. 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.

HUD and HHS Award Housing Vouchers. Information Bulletin # 371 (2/2013) Yesterday, HUD and HHS jointly announced the award of 3,530 housing vouchers for people with disabilities with extremely low-incomes, i.e., less than 30 percent of the median income. These vouchers were competitive among States and are targeted to people transitioning out of institutional settings or at high risk of homelessness. Each State housing agency had to partner with the State’s Medicaid agency in order to identify and coordinate the transitioning out of institutional settings, in order ‘to identify, refer and conduct outreach to persons with disabilities who required long-term services and supports to live independently.” In announcing the vouchers, HUD noted that “today’s announcement reinforces the guiding principles of the Americans with Disabilities Act and the landmark 1999 Supreme Court ruling in Olmstead v. L.C., which require state and local governments to provide services in the most integrated settings appropriate to meet the needs of individuals with disabilities.” For the 13 States that were awarded these vouchers, advocates can find the specific program targets, populations, and targeted areas HUD approved -http://portal.hud.gov/hudportal/HUD?src=/press/press_releases_media_advisories/2013/HUDNo.13-024 Advocates should be in contact with your State Housing Agency that won the vouchers and work to make sure the vouchers really go to the people with disabilities and are in the most integrated setting. Here are the 13 States that won this competitive process. State Housing Agency # of units California Housing Finance Agency 335 Delaware State Housing Authority 170 Georgia Housing & Finance Authority 150 Illinois Housing Development Authority 826 Louisiana Housing Corporation 200 Massachusetts Dept. of Housing & Community Development 100 Maryland Dept. of Housing & Community Development 150 Minnesota Housing Finance Agency 95 Montana Dept. of Commerce 82 North Carolina Housing Finance Agency 562 Pennsylvania Housing Finance Agency 200 Texas Dept. of Housing & Community Affairs 385 Washington State Dept. of Commerce 275 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.

Jobs, Economic Development, and Medicaid Expansion. Information Bulletin #370 (2/2013). In the last three Information Bulletins, we discussed the Affordable Care Act’s Medicaid expansion which provides access to medical care for all people whose incomes are under 138% of the federal poverty level. We discussed the impact on people with disabilities and on hospitals. This Information Bulletin looks at the broader economic impact. Medicaid expansion’s extraordinary impact on State employment and economic development is true for all states, but the loss for those States that do not agree to expand will be devastating. Has your State agreed to Medicaid expansion (which begins in January 2014)? [Fact Sheets for States are available. Email address below and identify your State.] If your State is still struggling with high unemployment and remains stalled in post 2007 economic recovery, these federal funds unequivocally will increase employment throughout the State, reduce State taxes as more people become employed, and have a profound economic multiplier effect throughout your State’s economy. If your State has not yet agreed, your task is clear. There are no other new federal programs that offer your State 100% federal reimbursement for three years for providing health care to hundreds of thousands of low-income people, and then a federal guarantee of no less than 90% federal reimbursement in year six and thereafter. 1. Here are some examples of the new federal Medicaid funds that will come into these States for the next six years, if they agree to Medicaid expansion: Alabama $9.835 billion in new federal funds Florida $18.817 billion Indiana $8.057 billion Louisiana $6.936 billion Michigan $13.566 billion New Jersey $8.497 billion N. Carolina $19.683 billion Oklahoma $1.630 billion Tennessee $10.356 billion Virginia $9.131billion Show me the money? There it is - not play money, but real money! Some States have voiced concern with the reliability of the federal commitment. If sometime in the future the federal government changes its reimbursement level, then State governments could reconsider their commitment as well. We think the State governments have the federal government over-the-barrel. We do not buy the argument that “once a program begins, it cannot be ended.” Many States have terminated existing program. If your State is worried, make your State’s Medicaid expansion explicitly dependent on the federal commitment. 2. If your State thinks of itself in economic development terms, it should want to know the guaranteed federal rate of return, i.e, how much federal funds for each State dollar. Here are some examples: Alabama $21.90 federal dollars to $1.00 State dollar Kentucky $23.10 to $1.00 Louisiana $21.60 to $1.00 Michigan $20.80 to $1.00 Mississippi $23.00 to $1.00 New Jersey $16.90 to $1.00 Oklahoma $22.20 to $1.00 S. Carolina $23.10 to $1.00 Utah $23.70 tp $1.00 W. Virginia $23.10 to $1.00 We do not believe that any State can invest one State dollar and receive these returns anywhere else, and we believe that any good business person would jump at those rates of return. There is no rational business reason, and it makes no business sense whatsoever to not participate. Is your State concerned about jobs and employment? Let’s look at one example of the employment impact as a result of the increase in newly eligible Medicaid recipients. Medicaid expansion will result in hospitals hiring more personnel to meet the increased demand for Medicaid services. Because we’re talking large hospital increases in Medicaid reimbursements for health care, that means hospital employment at all economic levels. 3. Here’s the approximate one year increase in hospital reimbursements as a result of Medicaid expansion, which will translate into jobs. Florida $2.4 billion Louisiana $630 million Michigan $442 million Mississippi $593 million Missouri $881 million New Jersey $253 million N. Carolina $971 million Oklahoma $494 million Tennessee $359 million Texas $2.807 billion Virginia $411 million ADVOCATES: You can convince your State to participate. Ohio, New Mexico, Nevada and Arizona have recognized the extraordinary economic implications of Medicaid expansion and last month announced their States were signing on. You can convince your State to sign on. Here are a few suggestions. 1. We do not believe that the newspapers and other media have looked at and understood Medicaid expansion as an economic issue. Write letters and columns. Educate the media! 2. We hope your State Chamber of Commerce has reviewed Medicaid expansion as an economic issue. Telephone them. Ask them if they want economic development and employment, and if yes, what are they doing regarding Medicaid expansion? 3. Most legislators have so much on their plates that they cannot or do not understand Medicaid expansion from an economic perspective. Even though it will not require any state funds for three years, so the 2013-2014 budget may not be impacted, nevertheless get to your legislative leaders and explain Medicaid expansion from an economic perspective. 4. Each State has a hospital trade association. What are they doing? How about the Managed Care industry? Home health? Nurses? Pharmaceuticals? They all will expand their services, hire more people, and help your State grow. Get to them We realize every advocate has a long agenda. Medicaid expansion is the most important step in health care since 1965 and in economic recovery since 2008. Make sure your State joins in! 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.