Iowa Opens The Doors To Medicaid Coverage, On Its Own Terms
Eventually Branstad said "yes," but only if Iowa could take the money on its own terms. The state legislature, which is evenly split between Republicans and Democrats, came up with an alternative: Federal expansion dollars would pay for managed care policies that poor people would select on the HealthCare.gov site.
Unlike in other states, these new Medicaid recipients will pay a premium — $20 a month.
Iowa's plan also provides incentives for people on Medicaid to monitor their health. Branstad calls it having "skin in the game."
Iowa is one of a handful of states that negotiated or are negotiating with the federal government to customize their Medicaid expansion and still get federal funding. Branstad notes that "other states, like Tennessee and Pennsylvania, are looking at our plan."
The federal Department of Health and Human Services' decision to grant Iowa a waiver to try this idea is not surprising, according to Joan Alker, executive director at the Georgetown University's Center for Children and Families, a policy research center. She says that the Obama administration "is willing to bend over backwards to get to 'yes,' " to show Republican governors how much flexibility they have in experimenting with Medicaid expansion in their states.
But "there are some lines they can't and will not cross," Alker says. While Iowa beneficiaries have to pay something for premiums and non-emergency care, recipients "can't be disenrolled if they're unable to pay those premiums," she says. "That's important, because we already have plenty of evidence to suggest that charging premiums to people below [the] poverty [line] will mean that they can't afford them and they're likely to lose their coverage."
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Medicaid Enrollment Is Brisk Despite HealthCare.gov Troubles