Medicaid Expansion: Indian Specific Provisions

Since Medicaid expansion is voluntary, only one state to-date, Minnesota, has enacted and signed into law legislation to expand Medicaid. Twenty-six governors have announced their support of Medicaid expansion in their states. However, Medicaid expansion approval depends not only on the governor’s decision, but the state legislature to garner support. Some state legislators do not support Medicaid expansion even though the governor does, and vice versa. Therefore, there is currently great flux with Medicaid expansion.

Although the federal government will cover 100% of Medicaid costs for newly eligible beneficiaries for states participating in the Medicaid expansion, some states are still concerned about footing the 10% of the remaining Medicaid bill after the federal match rates decreases to 90% after three years. As a response, some states are looking to privatize Medicaid and enroll Medicaid beneficiaries into accountable care organizations to accumulate state savings. States can do so by applying for state waivers.

New Mexico 1115 Demonstration Waiver for Centennial Care

New Mexico applied for a section 1115 demonstration waiver for its new Centennial Care, which would mandatory enroll Medicaid beneficiaries  including AI/AN into managed care. However, due to the lack of Tribal consultation, CMS denied the waiver. After revisions, New Mexico reapplied for the provision, with the correction that all AI/AN can opt out of managed care,. See the letter: Letter-CMS-to NM-Denying Mandatory Mgd Care for NA-2013-03-05