Medicaid at the Ballot Box: More Coverage or More Barriers? (Part 2)

Large Roll Of I Voted Today Stickers Ready For Voters In The Us

I blogged earlier about which of the 17 non-expansion states might see a change in their status on the horizon post election. Today I take a look at states that already have expanded (yes, I count Maine as an expansion state despite Governor LePage’s best efforts to thwart the will of the people), where we might see a change in Medicaid Section 1115 waiver and/or expansion policy post election. Wisconsin is on this list as well even though Wisconsin has not taken ACA expansion funds but expanded to 100% of the federal poverty line (FPL) at the regular match rate not the enhanced rate offered to states that expand Medicaid to individuals at 138% of FPL.

Let’s start with Maine which has a pending waiver with a number of harmful provisions, including limiting retroactive eligibility, imposing premiums and work requirements on parents and other adults. Janet Mills, the Democratic candidate for Governor, has said she will pull back waiver and move quickly to enact expansion which was passed by the voters by a wide margin in November 2017 but has been delayed by retiring Governor LePage’s efforts to obstruct implementation.

There are a number of other states that have close races for Governor where waiver proposals are pending that include barriers to coverage that may be pulled back if the Democrat wins. These include the recently approved Wisconsin waiver (which conditions eligibility on compliance with healthy behaviors, work requirements, and premiums) and pending proposals in Michigan, Ohio, and Florida (limiting retroactive coverage).  For more details on these proposals see the Kaiser Family Foundation’s waiver tracker.

Two states have possible changes in store to their existing expansions if the Republican candidate wins. The first is Connecticut, where the Governors’ race is a toss -up and Republican candidate Bob Stefanowski says he supports work requirements. Alaska is another toss-up where the Republican candidate, Mike Dunleavy, may try to put some new limits on the expansion.

Finally, residents of every state should keep an eye on Medicaid if the election results in Republicans maintaining control over both bodies of Congress. Senate Majority Leader McConnell has already said that they plan to attempt to repeal the Affordable Care Act again. With the deficit growing as a result of the tax bill,  it is highly likely that proposals to cut and cap Medicaid funding and rollback expansion altogether will resurface yet again. Jonathan Cohn does a good job explaining what’s at stake here.  

This is part 2 of “Medicaid at the Ballot Box” blog series. 

Joan Alker
Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy