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Governor Kelly Calls for Medicaid Expansion

from Prepared by: Dodie Wellshear, Ad Astra Government Relations

A Kansas governor, for the first time, has proposed expanding Medicaid to individuals up to 133% of the federal poverty in the Governor’s Budget. Governor Laura Kelly has been a strong proponent of the expansion since its inception in the Affordable Care Act. She considers health care access to be one of her top priorities over the next four years.

The Governor recommends $14.2 million to draw down an enhanced 90% match from the federal government. The program would be extended to an estimated 150,000 low income individuals across the state. Governor Kelly in her budget narrative states that expansion “will be particularly helpful for our struggling rural hospitals by reducing the level of uncompensated care.”

Medicaid expansion remains one of KAFP’s top legislative priorities and recent polling shows 77% of Kansans agree. However, GOP leadership has strongly opposed the expansion and continues to have concerns about fiscal sustainability in future years, as the federal government’s funding share is reduced.

There is growing discussion among GOP leaders regarding the need for additional coverage options in the state, including possibly developing an expansion plan that is Kansas-specific and includes some sort of work requirements. Advocates have generally eschewed the requirements in the past and in earlier ACA implementation stages the federal Center for Medicaid Services (CMS) rejected work requirements. More recent applications by some states have been approved with some element of work requirement.

Two years ago, the Legislature handily passed Medicaid expansion, but the legislation was vetoed by Governor Brownback and the Legislature fell just a few votes short of a veto override. This year there are likely enough votes in the House to pass the legislation, with the 40 Democrats and 30-35 Republican members who would join in supporting the legislation in that chamber.

The Senate, though, is not as certain. In addition to the eleven Democratic senators, ten Republican senators would be needed to pass the legislation in that chamber. That is doable, but one of the surest supporters of Medicaid expansion – Vicki Schmidt – is now Kansas Insurance Commissioner and her replacement leans more conservatively on the issue.

The real challenge, though, is getting the measure to the floor of the chambers, as GOP leadership has been very careful about putting any legislation up for floor debate in which Medicaid expansion might be amended in.

Other Budget Items
The Governor recommended $7.1 million in additional funding over the next two years to improve the “speed and accuracy” of the Medicaid eligibility determination process. The process has such a backlog that applicants are experiencing long waits for needed health care access, putting the state at risk for a lower federal funding drawdown.

In FY 2020, the federal government will begin reducing their investment in the Children’s Health Insurance Program (CHIP). The Governor’s Budget adds $12.4 million state funding in FY 2020 to cover increases in both costs and eligible children, in addition to the increase in the required state funding share.

KAFP Priorities in the 2019 Legislature
Many of the issues we’ve seen in recent years are likely to reemerge in the coming session. Scope of practice expansions, particularly by APRNs and pharmacists, are sure to be a subject of continuing debate in the health committees. KAFP will oppose any effort toward independent practice of medicine that does not include a collaborative physician agreement. Integrated medical teams, supervised by physicians continue to provide best for patient care and safety.

Opioid addiction remains a topic of critical concern all across the country, no less in Kansas. Kansas has been ahead of the curve on this is more

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