Federal judge rules in favor of experimental Georgia Medicaid program

U.S. District Judge Lisa Godbey Wood ruled August 19 in favor of Georgia after the Centers for Medicare and Medicaid Services (CMS) rescinded a Medicaid waiver for the state’s Pathways to Coverage program. Georgia brought the lawsuit after CMS under the Trump administration approved the state’s Section 1115 application for the waiver in October 2020 and then rescinded the waiver in early 2021 under the Biden administration, formally denying the application in December 2021. Georgia Gov. Brian Kemp (R) sent a letter notifying CMS that the state was filing a lawsuit on January 19, 2022.

Judge Wood said CMS’ 2021 decision to revoke the waiver authorizing Georgia’s experimental Pathways to Coverage program was arbitrary and capricious.

Georgia officials say the Pathway to Coverage program would extend Medicaid assistance to additional individuals below the federal poverty line. It would offer healthcare coverage to individuals who work at least 80 hours per month or spend at least 80 hours per month engaged in another qualifying activity (including college, community service, and vocational training) who would not otherwise qualify for assistance under traditional Medicaid programs. The program would also cover health premiums for qualifying individuals with insurance from their employers.

The program would not establish new qualifications for individuals currently eligible for Medicaid.

CMS has not yet filed to appeal the decision.

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Signatures for marijuana and Medicaid initiatives submitted in South Dakota

In South Dakota, two separate campaigns submitted their petition signatures on May 3 to get their initiatives on the ballot in November. The signatures were submitted to the secretary of state’s office on Tuesday afternoon.

One initiative, sponsored by the Dakotans for Health campaign, aims to expand Medicaid in South Dakota to adults between 18 and 65 years old with incomes below 133% of the federal poverty level, which is currently about $18,000 for an individual or $37,000 for a family of four. This statutory initiative is in addition to a constitutional amendment that is already on the ballot—Constitutional Amendment D, which also expands Medicaid but amends the constitution. The co-founder of Dakotans for Health argued that voters may be more supportive of an initiated law rather than a constitutional amendment.

The other initiative aims to legalize marijuana for those 21 and older. This measure joins a group of potential marijuana ballot measures in 2022—one marijuana ballot measure is already certified in Maryland, while 18 total marijuana ballot measures have been proposed in other states in 2022.

Both campaigns have reported submitted over the threshold of signature requirements. Campaign director of South Dakotans for Better Marijuana Laws, Matthew Schweich, stated that circulators collected 19,250 signatures. Meanwhile, 23,000 signatures were filed for the Medicaid expansion measure. 

Each campaign must have at least 16,961 verified signatures to qualify for the ballot. In South Dakota, this number is equal to 5% of votes cast in the previous gubernatorial election.

In South Dakota, 47 initiatives appeared on the ballot between 1985 and 2020. Twenty (42.6%) of these initiatives were approved by voters, while 27 (57.5%) of them were defeated.

If both initiatives qualify for the ballot, they will join two other ballot measures already certified on the South Dakota ballot in November—Constitutional Amendment C, and Constitutional Amendment D. Constitutional Amendment C would require a three-fifths supermajority vote for initiatives that increase taxes or fees that require the state to appropriate $10 million or more in the first five fiscal years.

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Missouri voters will decide on Medicaid expansion August 4

Missouri voters will vote on Amendment 2, the Medicaid Expansion Initiative, on August 4. Amendment 2 would expand Medicaid eligibility in Missouri to adults that are between the ages of 19 and 65 whose incomes are at or below 138% of the federal poverty level. The amendment would also prohibit any additional restrictions or requirements for the expanded population to qualify for Medicaid coverage than for other populations that qualify for Medicaid coverage. It would also require the Missouri Department of Social Services and the Missouri HealthNet Division to submit state Medicaid plan amendments by March 1, 2021, to the U.S. Centers for Medicare and Medicaid Services to implement Medicaid expansion.

The following populations are currently eligible for Medicaid in Missouri:

• Over 65 years of age,
• Blind or disabled,
• Adults with dependent children with a household income at or below 22% of the federal poverty level,
• Infants under the age of one in a household with an income at or below 196% of the federal poverty level,
• Children between the ages of one and 18 in a household with an income at or below 150% of the federal poverty level, and

• Pregnant women with a household income at or below 196% of the federal poverty level.

Amendment 2 was sponsored by Yes on 2: Healthcare for Missouri. The campaign submitted 341,440 signatures to the Missouri Secretary of State on May 1, 2020, to qualify the measure for the ballot. In Missouri, the number of signatures required to qualify an initiated constitutional amendment for the ballot is equal to 8% of the votes cast for governor in the previous gubernatorial election in six of the eight state congressional districts. The initiative qualified in districts 1, 2, 3, 5, 6, and 7. A total of 172,015 valid signatures were required, and a projected total of 258,686 signatures submitted by the campaign were valid in those districts.

There are two political action committees, Healthcare for Missouri and Missourians for Healthcare, registered to support Amendment 2. As of July 27, 2020, the committees had raised a total of $10.1 million, with Missourians for Healthcare receiving the bulk of the contributions. The top five donors to the campaign included the Missouri Hospital Association, the North Fund, the Health Care Issues Committee of the Missouri Hospital Association, the Health Forward Foundation, and the Washington University.

The support campaign argued that the coronavirus pandemic has shown the need for Medicaid expansion. Jack Cardetti, a spokesperson for the Yes on 2 campaign, said, “Now more than ever, Missourians need to be able to access care in their own communities and protect thousands of local frontline healthcare jobs. … Amendment 2 will help keep rural hospitals and urban clinics open by bringing $1 billion of our own tax dollars back from Washington, instead of going to the 37 other states that have expanded Medicaid.”

No on 2 in August is leading the campaign in opposition to Amendment 2. The committee organized in early June and has reported $112,000 in contributions. Opponents have argued that expanding Medicaid is not economically prudent. State Senator Bob Onder (R-2) said, “The money needed to expand Medicaid is going to come from somewhere. It either has to come from education, from roads or from massive tax increases. … I do think that Missourians, particularly in these challenging economic times, will realize that a massive expansion of the Medicaid program isn’t something that we can afford.” Missouri Governor Mike Parson (R) also came out in opposition to expanding Medicaid. He argued, “I don’t think it’s the time to be expanding anything in the state of Missouri right now. There’s absolutely not going to be any extra money whatsoever.”

In 2017, Maine was the first state to vote on a ballot initiative to expand Medicaid. It was approved. In 2018, ballot initiatives to expand Medicaid in Utah, Nebraska, and Idaho were approved. A 2018 initiative in Montana that would have renewed Medicaid expansion and increased tobacco taxes was defeated. On June 30, 2020, Oklahoma approved an initiative to expand Medicaid. It was approved 50.5% to 49.5%. Maine, Utah, and Oklahoma expanded Medicaid with opposition from Republican governors. Idaho expanded it with support from its Republican governor. Nebraska Governor Pete Ricketts (R) did not take a side on the question.

In Missouri, all polling places are open from 6:00 a.m. to 7:00 p.m. Central Time. Missouri voters may vote by mail with notarization of the ballot envelope. If a voter is in an at-risk category for contracting COVID-19, the voter may vote via absentee ballot without notarization. The deadline to request a mail-in ballot was July 22. Absentee ballots may be requested in-person until August 3. All ballots must be received by 7:00 p.m. on election day.

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Oklahoma voters approve State Question 802 to expand Medicaid

Voters in Oklahoma approved State Question 802 to expand Medicaid. With 100% of precincts reporting, the vote was 50.5% (340,279) in favor to 49.5% (333,761) opposed.

State Question 802 was designed to expand Medicaid in Oklahoma under the Affordable Care Act (ACA), also known as Obamacare. It would amend the state constitution to provide Medicaid coverage for certain low-income adults between 18 and 65 with incomes at or below 133% of the federal poverty level (FPL). For 2020, the FPL is $12,490 for individuals and $25,750 for a family of four. Because the ACA includes a 5% income disregard, this measure would effectively expand Medicaid to those with incomes at or below 138% of the federal poverty level.

Medicaid is a government program that provides medical insurance to groups of low-income people and individuals with disabilities. The Affordable Care Act (ACA), also known as Obamacare, provided for the expansion of Medicaid to cover all individuals earning incomes up to 138% of the federal poverty level. In 2012, the U.S. Supreme Court ruled in NFIB v. Sebelius that the federal government could not withhold funds from states that refused to expand Medicaid. The ruling had the practical effect of making Medicaid expansion optional for states. In 2018, the federal government financed 94% of the costs of state Medicaid expansion. For 2020 and subsequent years, the federal government was set to cover 90% of the costs. As of 2020, 14 states, had chosen not to expand Medicaid.

Oklahomans Decide Healthcare led the campaign in support of the initiative. Oklahomans Decide Healthcare said, “Expanding Medicaid will [make] our families healthier and our economy stronger. It will deliver healthcare to those who need it, including many parents, seniors, and hardworking folks who earn less than $17,000 a year. It will also bring more than a billion of our tax dollars home from Washington, D.C. every year to create jobs, boost our economy, and keep our rural hospitals open. That’s money that 36 other states that have expanded Medicaid get, but Oklahoma has lost out on for years.” State Question 802 was supported by the Oklahoma Hospital Association, State Medical Association, Osteopathic Association, and Nurses Association.

Vote No on 802 Association registered with the Oklahoma Ethics Commission to oppose State Question 802. The committee was chaired by John Tidwell, state director of Americans for Prosperity. Tidwell said, “State Question 802, which will force Medicaid expansion, will overwhelm our already struggling state budget and hurt those that the program was intended to help. There is no question that overburdening an already fragile system will lead to cuts of core services we all rely on and trigger tax increases at a time when Oklahomans can least afford additional financial burdens. Oklahoma must vote no on State Question 802.”

Oklahoma Governor Kevin Stitt (R) also opposed the initiative. A spokeswoman for Stitt said, “If SQ 802 passes, our state agencies will experience deep cuts, because the ballot measure offers no mechanism to pay for it. The governor does not support this unfunded mandate.”

In 2017, voters in Maine approved the first-ever ballot initiative to expand Medicaid according to an optional provision of Obamacare.

In 2018, voters in Idaho, Montana, Nebraska, Oregon, and Utah decided citizen-initiated measures concerning Medicaid expansion and the funding of expanded Medicaid coverage.