Sunday, March 9, 2014
WASHINGTON — Governors across the country said Wednesday they are struggling with rising Medicaid costs and federal inflexibility in administering a program that consumes an ever-larger share of state budgets.
The complaints echo those of Maine Gov. Paul LePage, who received rare federal approvals this week to scale back Medicaid eligibility rules -- and eliminate health coverage from thousands of Mainers -- to help balance the state's budget. LePage did not attend the National Governors Association meeting here Wednesday.
Oklahoma Gov. Mary Fallin, a Republican, described Medicaid as one of the biggest budget issues for states this year. Speaking at the conference, Fallin urged the Obama administration to grant states more flexibility to change or cut back the program that provides health care coverage to millions of low-income, elderly and disabled Americans.
Each state has different rules for the Medicaid programs, but the federal government -- which pays most of the costs -- has to approve changes by granting waivers or exemptions.
"We would like to see the administration embrace innovation at the state level by speeding up the consideration of waivers and looking on them more favorably," said Fallin, vice chair of the National Governors Association. "Unfortunately in the past, many of our states have found the waiver process can be very long, it can be very difficult and it also can be very time-consuming to prepare."
Fallin made her comments two days after federal health officials agreed to allow Maine to cut or reduce Medicaid services to roughly 20,000 residents.
The U.S. Department of Health and Human Services will allow Maine to eliminate coverage for working parents earning between 133 percent and 200 percent of the poverty level, and to cut or reduce Medicaid health care or prescription drug coverage for some elderly participants.
But the agency denied LePage administration requests for much deeper cuts that would have eliminated coverage for 15,000 lower-income parents and for 6,800 low-income 19- and 20-year-olds.
The DHHS decision was unpopular on all sides of the oftentimes contentious debate over Maine's Medicaid rolls.
Critics of the LePage administration's request contend that Maine should not be eliminating health care options for vulnerable populations. But LePage administration officials and its supporters criticized DHHS for blocking Maine's attempts to stabilize costs in its Medicaid program.
Adrienne Bennett, spokeswoman for LePage, said the administration expected some of the exemption requests to be rejected. So the administration did not incorporate those savings into the state budget being finalized this week, Bennett said.
"What it affects is our ability to make the changes that are needed for the state to have a sustainable, affordable safety net," she said. "Until we can make strategic, long-term changes to our welfare programs, we are going to continue to have budget shortfalls."
Maine is one of four states nationwide that DHHS may allow to make cuts -- "limited exemptions," in bureaucratic speak -- to Medicaid requirements under President Obama's landmark health care bill, the Affordable Care Act.
Other states, like Maine, are seeking waivers from DHHS for more flexibility in administering various aspects of Medicaid under the Affordable Care Act.
Fallin said the uncertainties facing states over Medicaid are also making it more difficult for states to decide whether to set up their own insurance marketplaces -- so-called exchanges -- or let the federal government do it.
Neither Maine nor Oklahoma plans to establish a state health exchange, meaning the state's residents will be covered under a federally administered program. LePage has said he doesn't believe the federal government would provide enough flexibility to the state to make a state-run exchange worthwhile.
"That has been one of our frustrations as governors," Fallin said. "We don't have all of the answers from HHS to make the decisions that we need to be able to make."
Washington Bureau Chief Kevin Miller can be contacted at (207) 317-6256 or at:
On Twitter: @KevinMillerDC