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.

The Disability Community and Medicaid Expansion: What’s At Stake. Information Bulletin #369 (1/2013). In 2010 Congress enacted the Affordable Care Act. One part of this legislation mandated that all States expand their Medicaid to all persons whose incomes are under 138% of the federal poverty level, which is less than $15,415 per year for a single person and less than $31,809 for a family of four. In June 2012, the U.S. Supreme Court held that Medicaid Expansion could not be a mandate, making Medicaid Expansion optional for States. This Fact Sheet explains why Medicaid Expansion is vitally important to people with disabilities. Based on data from the 2010 American Community Survey for people under 65 years old, 13.7% of non-elderly community residents with family incomes under 138% FPL have disabilities, compared to 6.7% of those with incomes above that level. So the disability rate among poor or near-poor Americans is more than twice that of those with higher incomes. For people with disabilities on SSI, they already receive Medicaid. Also, in many States that provide Medicaid Waivers for community-based services for people with disabilities, the income eligibility levels are above SSI. However, there are a LOT of people with disabilities in every State who are neither on SSI nor on a Waiver and who do not have any health coverage for basic health care – doctors, prescriptions, and hospitalizations. These are the people with disabilities for whom Medicaid Expansion is critical! What follows are the number of people by State who are at 138% of the federal poverty level and under, who are not currently receiving Medicaid, either based on SSI or Waiver, and are under 65 years. While a majority of States are opting into the Medicaid Expansion, a number have not yet decided it is in their economic interest or the interest of people with disabilities. [We also have separate Fact Sheet for the recalcitrant States. It makes an economic development argument why the States should participate. If you want it for your State, just email me with the name of your State.] Disability Advocates - here are the number of people with disabilities who will benefit if your State Expands Medicaid eligibility! # People with Disabilities under 138% FPL, under 65, and not currently on Medicaid Alabama 77685 Alaska 6550 Arizona 37366 Arkansas 44130 California 227747 Colorado 35162 Connecticut 16640 Delaware 5269 District of Columbia 3774 Florida 190073 Georgia 105420 Hawaii 5623 Idaho 16118 Illinois 80884 Indiana 67339 Iowa 19183 Kansas 24259 Kentucky 76619 Louisiana 67078 Maine 12465 Maryland 31616 Massachusetts 19008 Michigan 109828 Minnesota 24521 Mississippi 51235 Missouri 67885 Montana 10475 Nebraska 13643 Nevada 21158 New Hampshire 10237 New Jersey 41611 New Mexico 20393 New York 102793 North Carolina 105627 North Dakota 3453 Ohio 121348 Oklahoma 49336 Oregon 49213 Pennslyvania 108012 Rhode Island 10213 South Carolina 60840 South Dakota 5878 Tennessee 80742 Texas 237253 Utah 12641 Vermont 3383 Virginia 59705 Washington 49436 West Virginia 34953 Wisconsin 31285 Wyoming 4197 0 U.S. 2665407 Steve Gold, The Disability Odyssey continues Thanks to Steve Kaye, UCSF 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.

Nursing Home Residents and My Medicaid Matters. Information Bulletin #368 (1/2013) Over the next year, States may try to reduce community-based Medicaid-funded services for both disabled and elderly people. When they do, advocates should instead force them to focus money going to the institutional Medicaid-funded services, i.e., nursing homes, the flip side to the community. Nursing homes, unlike the community, continue to receive increased Medicaid reimbursements. People who have “self-care” needs, i.e., who need assistance with activities of daily living, trigger both an ADA/Olmstead and a fiscal issue, depending on where they receive these Medicaid services – in the community or in an institution. Based on data collected and analyzed by Steve Kaye, Director, PAS Center, UCSF, advocates can use the following points in your State’s My Medicaid Matters struggle to show how to reduce institutional expenses. The point of the data is to enable advocates to ask why your State has so many non-elderly and non-cognitively impaired persons unnecessarily institutionalized. What follows are ratios of two specific subcategories of nursing home residents (1. non-elderly and 2. non-cognitively impaired) to the total state population with self-care difficulties in 2010. First, nationally, there was an average of 6.3 non-elderly nursing home residents per 100 non-elderly people with self-care difficulties. The ten worst States with much higher rates than 6.3 national average are ranked as follows: Illinois (#1 with 14.5 non-elderly N.H. residents), Connecticut (#2 with 12.2), North Dakota (#3 with 11.7), District of Columbia (#4 with 11.3), South Dakota (#5, 10.1), and then Ohio, Iowa, New York, Hawaii, and Missouri. Why do some States have twice the national average of non-elderly persons with disabilities institutionalized? With appropriate scope and quantity of community-based services, many of these non-elderly people could and would want to live in the community. Many States have addressed this and significantly reduced non-elderly persons in nursing homes – e.g., New Mexico has 2.8 non-elderly NH residents per 100 total NH residents, less than 25% of the worst State. The number of non-elderly persons in NH is a matter of State policy. What is your State doing to reduce this institutionalized population? Rather than reduce community-based services, reduce much more expensive NH residents and provide services in the community. Second, nationally, there was an average 7.5 nursing home residents (all ages) without cognitive impairments per 100 with self-care difficulties. The ten worst States with high rates well-higher than the national average are ranked as follows: North Dakota (#1 with 23.4 N.H. residents), Iowa (#2 with 17.0), South Dakota (#3 with 16.4), Connecticut (#4 with 16.2), Rhode Island (#5, 15.3) and then Nebraska, Kansas, Wyoming, Indiana, and Minnesota. States have addressed this and many have reduced this institutionalized population including, e.g., Oregon with only 3.1 non-cognitively impaired NH residents per 100 population with self-care difficulties, less than 13% of the worse State. Others include Alaska (2.3) and Arizona (4.3). Here’s another unnecessarily institutionalized group who should be addressed before community-based reductions are implemented. Third, States which have “rapidly rebalanced” their state Long-Term Care Medicaid expenditures, i.e., shifted more than 10% of their Medicaid funds from institutional care to community-based care, have reduced the total number of long-stay nursing residents by 9% between 2002 and 2010. In States that have not rapidly rebalanced their LTC budgets, there has been an increase in nursing home residents. Advocates must know what’s happening on the institutional side of the ledger. Look at the institutional expenditures over the past eight years. Has the N.H. per diem increased? Compare it to the community-based services. Are there people in N.H. who could be more inexpensively served in the community? Has the total N.H. population increased or decreased? The NH industry is a powerful player, but we have the data and the way to save money. If your State is threatening to reduce community-based Medicaid Long-Term Care services, use these three items to argue why such reductions are wrong. 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.

Medicaid Expansion, Disproportionate Share Hospital Payments, and a Train Wreck Waiting to Happen. Information Bulletin #367 (12/12). The Affordable Care Act has many pieces. Some of the pieces are interdependent. This Information Bulletin deals with two of those pieces to explain their interdependence and why it is important to you. When Congress enacted the Affordable Care Act in 2010, one provision (Medicaid Expansion) required Medicaid be provided to people who had not been previously eligible and whose incomes were under 133% of the federal poverty level, about $14,856 for a single person and $30,657 for a family of four. This mandatory Medicaid Expansion would have impacted approximately 21.3 million low-income people nationwide, beginning in January 2014. Another provision of the Affordable Care Act significantly reduced what was known as Medicaid payments to “Disproportionate Share Hospitals” (DSH). These were federal Medicaid reimbursements made annually to States for those hospitals that provided a significant amount of health care and service to many persons whose incomes had placed them above Medicaid, but who did not have private health insurance. At least 51% of these payments will be eliminated under the ACA by 2019. Medicaid DSH payments pretty much covered the same 21.3 million people Medicaid Expansion was intended to have covered. In 2010, when Congress enacted the ACA, Medicaid Expansion would have been mandatory on the States. The States would have had to provide Medicaid to the 21.3 million people. In return, the federal government would have paid 100% coverage of the costs of the 21.3 million for the first three year years and about 90% for the next three years. Mandatory Medicaid Expansion has virtually no incremental cost to the States. It has been estimated that between 2013 and 2012the federal share of the expansion to all States would be $800 billion and the States’ share $8 billion. Here’s how the DSH and the mandatory Medicaid Expansion were intended to be interdependent. With the enactment of the ACA, these 21.3 million people would have become Medicaid recipients and would have received services and care from the hospitals, which would then not need to have been reimbursed with DSH payments. As regular Medicaid recipients, no DSH reimbursement would have been necessary because States and then hospitals would have received direct Medicaid hospital reimbursement for these 21.3 million people. Then came the 2012 U.S. Supreme Court decision that held that Congress could not require States to implement Medicaid Expansion (even though it would cost the States virtually no State funds). What the Court did not deal with was that ACA had virtually eliminated DSH payments. Lo and behold – your hospitals can get royally shafted if your State does not opt to participate in the Medicaid Expansion. How? The States and then the hospitals will not receive either the DSH payments for these 21.3 million people that they had received prior to the ACA. If a State does not opt for Medicaid Expansion, these same 21.3 million people will still go to hospitals that must treat them, but the hospitals will not receive Medicaid reimbursement. Neither Medicaid nor DSH payments. For the hospitals and therefore for States that do not provide Medicaid Expansion, this is a train wreck waiting to happen. What’s the answer? States must provide for Medicaid Expansion so that hospitals can receive Medicaid reimbursements for care and services they provide to these 21.3 million people. Unfortunately, many States appear to be considering not voluntarily participating in Medicaid Expansion. We cannot believe that those States have factored in the DSH losses to their hospitals. From purely a financial viewpoint, States will significantly benefit if they expand Medicaid and ensure hospitals receive Medicaid reimbursement for the care and services they provide to the 21.3 million people. Disability and Elderly Advocates: 1. Get to your statewide Hospital Associations. They have paid lobbies that know how to work the political process. Join their efforts to convince your Governors and State legislators to enact Medicaid Expansion. Timing is critical since State budgets are being planned NOW for 2014. 2. Most newspapers, etc. do NOT understand how the ACA’s Medicaid Expansion fits together with the DSH payments. Explain it to them. Governors in the following States have threatened not to expand Medicaid in 2014. We are not sure how much is just huffing and puffing. Here are the approximate annual DSH Medicaid funds their States have received and potentially will lose, if Medicaid Expansion does NOT occur in these States. ANNUAL MEDICAID DSH PAYMENTS TO (SELECTED) STATES: Alabama $445,819,332 Arkansas $61,416,819 Connecticut $162,627,439 Florida $241,187,904 Indiana $121,122,632 Kansas $46,807,379 Kentucky $173,659,743 Louisiana $770,957,650 Michigan $338,776,418 Mississippi $204,084,644 Missouri $525,857,264 Nebraska $47,698,173 Nevada $95,232,395 New Jersey $975,416,270 New Mexico $28,851,260 Oklahoma $40,706,148 Ohio $566,951,426 Pennsylvania $534,244,593 Rhode Island $122,720,991 New Jersey $930,234,696 South Carolina $415,604,650 Tennessee $151,396,268 Texas $1,286,627,916 Utah $25,914,531 Virginia $192,435,368 West Virginia $55,087,700 Nationwide $15,019,365,273 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.