As holdout states consider whether to accept the Biden administration’s offer of enhanced federal funding to expand Medicaid, a recent evaluation report on Indiana’s conservative Medicaid expansion demonstration may hold some lessons learned for states that look to managed care plans to do some of the heavy lifting for such programs.
The American Rescue Plan, signed into law by President Joe Biden in March, extends a five percentage-point bump in the Medicaid Federal Medical Assistance Percentage (FMAP) to states that newly expand Medicaid eligibility for all adults with income up to 138% of the federal poverty level (RMA 3/18/21, p. 8). Fourteen states have yet to expand Medicaid under the Affordable Care Act, although lawmakers in Tennessee have reportedly expressed an openness to exploring it while advocates in other red states like Georgia continue to push hard for expansion. Voters in Missouri and Oklahoma last year approved Medicaid expansion via a ballot measure (RMA 8/6/20, p. 1), but Republican lawmakers in Missouri are now trying to keep expansion out of the next budget. Funding-related uncertainties also face Oklahoma, which recently submitted a request to amend its SoonerCare demonstration to begin enrolling expansion adults in the next fiscal year.