CONCORD — House Speaker William O'Brien wants state social services officials to keep lawmakers informed about the Medicaid program's possible expansion under the Affordable Care Act.
In a letter to state Health and Human Services Commissioner Nicholas Toumpas dated Monday, O'Brien notes the recent U.S. Supreme Court ruling leaves it up to the states whether to expand Medicaid eligibility in 2014 to provide health care to more uninsured residents.
“The Legislature has an obvious interest in how we proceed and we want to work with the Department of Health and Human Services through this new landscape, both through discussions and the process and authority of the Joint Health Care Reform Oversight Committee,” O'Brien wrote.
No determination has been made on how states will either join the program or opt out or how a state would arrive at a decision on the expansion. For example, could the governor or commissioner decide to go forward with the expansion or will it need legislative approval? However, if the program is expanded, the money will have to be in the state's operating budget that lawmakers craft and send to the governor.
O'Brien asks Toumpas to inform him of any decisions from federal officials and lists a number of concerns, including who will make the decision, if the decision is final, the process for opting in or out and the impact on the state's taxpayers if the program is expanded.
Also of concern to the speaker is a provision in the ACA requiring states to maintain the eligibility standards in place March 23, 2010, when the law was signed for both Medicaid and the Children's Health Insurance Program.
The intent was to block states from reducing services before the health exchanges begin Jan. 1, 2014. The Children's Health Insurance Program provisions continue until Sept. 30, 2019.
If a state violates the requirement, it could lose all its federal funding for both programs.
“Does the ruling's Medicaid component release the state from this provision without threatening federal participation?” O'Brien asks and wonders “does the ruling have any impact on the implementation of managed care for the Medicaid program?” Toumpas said Monday he has people working on the issue and will respond to the federal rule which has been proposed and also to the speaker's requests when more information is available.
“We're in the process of crafting a response,” Toumpas said. Typically, the federal government will reach out to states seeking a response and sometimes the advice is followed and sometimes it is not, he said.
The state is on the verge of implementing a managed care program for Medicaid participants, with the start date set for Jan. 1.
The state is waiting for the Center for Medicaid Services to approve the waiver needed for the state to change to a managed care program which is projected to save $16 million in the current fiscal year.
O'Brien also suggests Toumpas hold a briefing for lawmakers when he receives more information from federal officials on the process for states.
“The Supreme Court ruling has created more confusion than lucidity for Medicaid, the largest program in state government,” O'Brien wrote.
“House, and I am sure, Senate members are anxious to understand the potential impact for their constituents.”