Medicaid Directors Worried Over Expansion, Indiana's Says Federal Government Is Not Giving Enough Guidance

The new health law calls for dramatic increase in Medicaid programs, the joint federal-state health coverage for low-income residents. Some state Medicaid directors say they are worried about how that expansion will work and some are complaining that they are not getting enough guidance from federal officials.

The Associated Press: "Indiana's Medicaid chief told [state] lawmakers Thursday that the federal government has largely left states in the dark on implementing the federal health care overhaul because it hasn't yet provided needed guidelines. Medicaid Director Pat Casanova told the Health Finance Commission that key parts of the overhaul take effect in 2014 — about 3 1/2 years away — but states will need several years to pass their own rules and implement the overhaul." Indiana has less than 90 people on its Medicaid staff and is also struggling to implement privacy rules and health information technology benchmarks. State Rep. Ed DeLaney, an Indianapolis Democrat, "also criticized the administration of Republican Gov. Mitch Daniels for lagging behind other states in putting the health care overhaul into place and for leaving lawmakers 'out of that process.' He noted other governors have taken steps to implement provisions of the overhaul while Indiana waits" (Kusmer, 7/16).

CongressDaily: Medicaid budgets in many states are strapped because the recession has boosted the number of people eligible for benefits. The federal government has been providing enhanced contributions to help the states, but that ends at the end of the year and efforts in Congress to extend that funding have so far failed. "Without the additional federal funds, state administrators and Medicaid experts warn the expansion of Medicaid, required under the healthcare law, is threatened." The Medicaid expansion under the new health law will make all adults who make 133 percent of the federal poverty level and less eligible for the program starting in 2014. "But for the 30 states that have included the increased federal Medicaid funds in their budget, the current shortfall means cuts to services and payment rates for providers are likely if Congress does not act this month." States say they counted on the extension of increased Medicaid funds, called the Federal Medical Assistance Percentages, when they put budgets together last year. The increased federal match for state Medicaid programs was first authorized by the Stimulus program last year (McCarthy, 7/16).

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