In her State of the State address today, Governor Jan Brewer said that she will be asking the Arizona Legislature to move forward with an expansion of the Medicaid program for parents and childless adults to 133% of the Federal Poverty Level (FPL). Governor Brewer is proposing a provider assessment to pay for the state’s share and is making the expansion contingent upon the federal match remaining at its current generous level.

Governor Brewer’s decision signals a very significant step forward with respect to states deciding whether or not to extend Medicaid coverage. She is now the fourth Republican Governor (New Mexico, Nevada and North Dakota being the first three) to announce their intention to accept the generous federal funds to cover more uninsured people.  In an Associated Press article by Bob Christie, Governor Brewer  cited President Obama’s re-election and the Supreme Court ruling as evidence of the law’s permanence.

As readers of Say Ahhh! know, Arizona is an especially interesting case. In November, the Governor had submitted a waiver request to do a partial Medicaid expansion to 100% of FPL at full federal match, which, in effect, CMS turned down with the Secretary’s announcement in December that CMS would not consider such a request. But the Governor decided to go ahead and do the full expansion anyway! To me, this decision underscores that the offer is too good for states to refuse, especially with hospitals on deck to see substantial cuts in their DSH funding which covers uncompensated care.

The Medicaid regulation that was released earlier today also underscored that states do have quite a bit of flexibility with respect to benefits and cost sharing for the expansion population. But that is a story for another day…..