Most of Iowa’s Medicaid expansion waiver has been approved according to the Washington Post:
the Department of Health and Human Services has just notified Iowa that it is prepared to grant the state a waiver to pursue much of what it has asked for in response to its request for HHS approval to expand Medicaid-funded coverage to low income Iowans on the state’s own terms….
In Iowa, Governor Terry Branstad had declined to opt in to the Medicaid expansion, and he has been asking HHS for a waiver that would allow Iowa to pursue its own reform that would accomplish pretty much the same thing. Iowa’s solution would use federal money to expand coverage to poor Iowans by financing their premiums through the private market. Iowa also wants to charge those people premiums (at a discount if they agree to a health assessment) with the goal of putting the state’s own conservative stamp on the expansion by requiring Iowans to take charge of their health.
HHS just informed Iowa, I’m told, that they are mostly willing to go along with the state’s request, with a caveat. HHS is granting Iowa a waiver to pursue its own program, but without premiums charged on those up to 100 percent of the poverty line. Those between 100-138 percent of the poverty line would pay the premium.
So what will this tell us?
Another 150,000 or so people will get coverage. I’m betting their coverage won’t be effective 1/1/14. More likely the plans will be implemented in the 2nd quarter of 2014 due to implementation hurdles.
We also learn that HHS is quite willing to allow states to get fairly creative in how they go about expanding Medicaid in ways that provides coverage without having to call it a Medicaid expansion.
Finally poor people won’t get screwed. Assuming the Iowa expansion is a push to the Silver out of pocket assistance plans that Arkansas used in their waiver for the people above 100% federal poverty line, and 100% subsidy to those below 100% FPL, people will be getting coverage that clocks in at 96 or 97% acturial value for someone at 137% FPL and 100% for someone at 88% FPL.
As a second order tea leaf, the proposed Pennsylvania expansion waiver which Gov. Corbett has floated but not filed will get serious push back from the Feds. There are two areas of objections. The first would be premiums for people making less than 100% FPL and the second is work search requirements as a general humiliation step for quite a few people who are already working.