I have to admit, I was a bit too dour and pessimmistic in evaluating the probability of Republican dominated states expanding Medicaid in 2015. I figured it might be just the Mountain West submitting applications for program starts on either July 1, 2014 or January 1, 2015, but I was wrong. Tennessee is submitting a waiver to their legislature for approval to expand Medicaid. And given the circumstances, it looks to be a fairly reasonable waiver application.
The first part is very similar to Utah’s premium support model for people who work at places with employer sponsored coverage but can’t afford it:
Tennesseans 21 to 64 years old will be offered a choice of the Healthy Incentives Plan or the Volunteer Plan.
The Volunteer Plan would provide a health insurance voucher to participants that would be used to participate in their employer’s health insurance plan.
This is reasonable. The second portion is a modification of the Healthy Indiana’s HSA model that has not yet been waivered:
Participants in the Healthy Incentives Plan may choose to receive coverage through a redesigned component of the TennCare program, which would introduce Healthy Incentives for Tennesseans accounts, modeled after Health Reimbursement Accounts, which can be used to pay for a portion of required member cost-sharing.
I have not seen the actual waiver language as it has not been written yet. However if this is a deal in principle that the Centers for Medicare and Medicaid Services has signed off on, then the probable cost sharing maximums will be split into two groups. For people who make between 100% and 138% FPL, maximum cost sharing will be roughly the equivilent of cost-sharing Silver maximums, so they’ll be seeing 94% or 95% acturial value coverage. For people who make under 100% FPL and would not otherwise have qualified for Tennessee Medicaid, maximum cost sharing is probably under $300 per year if we use Utah as a benchmark for what CMS will approve.
This program should cover 150,000 more people.
So this is a good day for Tennessee and human decency.