Alaska governor to unilaterally expand Medicaid

Newly eligible beneficiaries could begin enrolling as early as September

Alaska Gov. Bill Walker (I) on Thursday said he will use his executive power to expand Medicaid through the Affordable Care Act (ACA).

Since Walker took office following the November 2014 elections, he has tried several times to expand Medicaid, but has been repeatedly rebuffed by the GOP-controlled state Legislature. State lawmakers inserted a provision in the current budget that says Walker cannot expand Medicaid, although lawyers for both the governor and the Legislature have said the provision is unconstitutional.

Walker says the unilateral move is "the final option" to expand coverage to about 40,000 low-income state residents.

Twenty-eight states and Washington, D.C., have expanded Medicaid through the ACA. Montana has passed an alternative Medicaid expansion plan and is in the process of developing a waiver to submit to CMS for approval.

Expansion plans

Walker says he will pursue a straightforward expansion of Medicaid to Alaskans with incomes up to 138% of the federal poverty level rather than seek a waiver for an alternative plan. The Walker administration projects that about 20,000 low-income residents will sign up for the program during the first year.

The governor on Thursday sent a letter to Alaska's Legislative Budget and Audit Committee, giving it the required 45-day notice that he plans to accept federal funding to expand the program. Walker says he has the authority to proceed with expanding Medicaid even if the committee declines to support his plan.

Who's saying no to the ACA? The states that might need it the most.

Officials have estimated that the state will bring in an additional $1.1 billion in federal funds over the next six years by expanding Medicaid eligibility.

"Every day that we fail to act, Alaska loses out on $400,000," Walker says, adding, "It would be foolish for us to pass up that kind of boost to Alaska's economy."

Walker says he hopes that newly eligible beneficiaries could begin to enroll in Medicaid in September.

Help your patients escape the patient access maze

GOP lawmakers criticize move

Republican state lawmakers have repeated their concerns about the state's existing Medicaid program and plans to expand it. However, they have not indicated that they will fight the move.

"Regardless of federal funding, we cannot afford the Medicaid system we have now," says state Sen. Pete Kelly (R), adding, "Our current system is broken. Adding tens of thousands of people to a broken system will do nothing to improve quality of care, access, or efficiency."

Meanwhile, state Senate Majority Leader John Coghill (R) says expanding Medicaid now would give the state less leverage over the Obama administration if it were to seek cost-saving changes to Medicaid. However, he says that Walker "has the upper hand in the process" (Quinn, Reuters, 7/16; Dickson, Modern Healthcare, 7/16; Goodnough, New York Times, 7/16; Sullivan, The Hill, 7/16; Radnofsky, Wall Street Journal, 7/16).

The 3-minute story behind Medicaid expansion


The Medicaid expansion makes for great political theatre, but there's a real story behind the drama: If, when, and how states choose to expand Medicaid has huge ripple effects on providers and patients.


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