By Miranda Moore / Kansas City Beacon / December 29, 2022
Kansas is one of 11 states that have not expanded Medicaid eligibility. Will 2023 be the year it passes?
Medicaid expansion is a popular policy among voters, in Kansas and across the country. More than 7 in 10 Kansas voters support expanding Medicaid eligibility, according to a survey from Fort Hays State University.
But that popularity hasn’t been enough to motivate lawmakers to pass Medicaid expansion, despite a decade of trying. Lawmakers introduced dozens of bills over the past 10 years with no success.
No matter the political pressure or bipartisan negotiating from Gov. Laura Kelly to see it passed, Kansas remains among a dwindling few states that have not adopted Medicaid expansion, leaving around 150,000 Kansans without health care, most of them too poor to afford it on their own. Only 11 states nationwide have yet to adopt it; a 12th approved it only in November.
This year, however, the debate takes on a new urgency: A federal public health emergency enacted in 2020 during the COVID-19 pandemic temporarily prevents states from kicking people off Medicaid. That protection may expire in 2023. When that happens, as many as 125,000 Kansans risk losing their Medicaid eligibility.
As lawmakers prepare for another legislative session to begin in January, Kelly has promised to push for Medicaid expansion yet again.
What is Medicaid and why expand it?
Medicaid expansion would allow more people to be eligible for Medicaid benefits. Medicaid is the federal government program through which people who meet certain criteria, including income requirements, can get publicly funded health insurance. In Kansas, Medicaid is administered through KanCare and limited to low-income adults who are seniors, are disabled or have children. Childless adults without disabilities who are under the age of 65 are not eligible for KanCare benefits.
Medicaid expansion would eliminate all KanCare eligibility criteria except income. Under expanded eligibility, anyone with a household income under 138% of the federal poverty level may qualify for Medicaid benefits, including adults without disabilities or dependents. For a family of three, that would be roughly $32,000.
Medicaid expansion was mandatory when it was first enacted as a part of the 2010 Affordable Care Act, also known as Obamacare. States that refused to expand Medicaid eligibility risked all of their federal Medicaid funding being cut, even funding already received.
In 2012, however, the U.S. Supreme Court decided that the government could not withhold funding for a state’s entire Medicaid program if that state decided against expanding Medicaid; only funding for the expanded part of Medicaid could be withheld. This effectively made Medicaid expansion optional. Of the 39 states plus the District of Columbia that have expanded Medicaid eligibility, half of them enacted it Jan. 1, 2014, the first day possible.
What would Medicaid expansion cost Kansas taxpayers?
If Medicaid expansion ever passes in Kansas, the federal government would pay for 90% of the costs, with Kansas on the hook for the remaining 10%. The federal government currently pays more than 90%, because of incentives enacted in response to the COVID-19 pandemic to encourage states to sign up.
Federal funding of already existing Medicaid coverage would remain the same as it is now, around 60%, according to the Kaiser Family Foundation.
Opponents of Medicaid expansion — many of them fiscal conservatives — have cited the cost to taxpayers as a reason to oppose it.
Fiscal estimates earlier in 2022 predict the state would spend around $600 million to pay for Medicaid expansion in its first year in Kansas. But most of that would be offset by federal funding. In the end, the state’s budget director estimates that Kansas would save nearly $70 million by enacting Medicaid expansion.
But a $70 million savings from Medicaid expansion hasn’t been enough to convince lawmakers to pass it.