Medicaid In Other States: Arizona, Maine, and Arkansas

The Medicaid Expansion dialogue got another big day of media coverage on April 1, with the Governor hosting one press conference of skeptics, and another group of elected officials supporting expansion.
CPPP’s statement on our bottom line priorities for Medicaid expansion in Texas emphasizes that the other conservative states striking bargains with the federal government to tailor programs that work for their states make it crystal clear that if Texas leaders are serious about finding a Texas Solution, our state can reach a win-win agreement too.
You can read here about the latest on the Arkansas premium assistance option, which allows officials to offer a solution for these poorest uninsured citizens, but without using a traditional Medicaid structure.  Arkansas appears near to a formal agreement with federal Medicaid officials that will let the state enroll the currently uninsured parents and other adults under 138% of the poverty income in the new health insurance Marketplace (the new name for the Exchange) in 2014.
On another Medicaid expansion debate topic, as we noted two weeks ago in our notes on the House Appropriations Committee hearing on Medicaid Expansion, opposing testimony from John Davidson of TPPF included a focus on the expansion of Medicaid to childless adults in Arizona in 2000 and in Maine in 2002, calling those state’s outcomes “disastrous.”
This surprised me because I have never heard folks from either AZ or ME express anything other than pride in their overall programs, each of which has been innovative in its own way.  Still, I knew that like most states they had adopted Medicaid cutbacks during the recession.  So, I did some research and came up with some important context for the gloomy assertions, which appear to have been authored by a Florida group (FGA) and then cited by others.
Generally, the FGA inappropriately holds adult Medicaid expansion responsible for growth and cost trends that actually occurred in most of the states—or even all states—over the period analyzed.  All of the trends erroneously blamed on adult Medicaid expansion in AZ and ME—increased Medicaid caseload growth, higher uninsured rates, declining employer sponsored insurance, and increased charity care—were trends also experienced in Texas despite the fact that Texas did not expand adult eligibility.  In fact, in most cases these trends actually accelerated faster in Texas than AZ and ME over the last decade.
Arizona and Maine were some of the pioneer states experimenting with covering more parents and adults in Medicaid over a decade ago, and our memo shows that while their expansions were not a silver bullets that solved the national trends of declining employer-sponsored  coverage or overcame the global recession, they nevertheless stayed ahead of Texas on almost every measure.

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