DRG takes a look at the results of the recent election cycle and offers an update on Medicaid for each impacted state.

In the 2018 midterm elections, voters in Idaho, Nebraska, and Utah bypassed Republican-controlled legislatures and governors and voted to expand Medicaid eligibility as called for under the Affordable Care Act. The three states join Maine, which, in November 2017, became the first state to put Medicaid expansion to a public vote. But in Montana, voters rejected a ballot measure that would have raised taxes on tobacco products to continue funding that state’s Medicaid expansion, which is set to end June 30, 2019.

Medicaid enrollment should experience a significant increase as a result of the expansions—if lawmakers do not stall implementation like the outgoing Gov. Paul LePage has done in Maine despite the vote.

In Idaho, Proposition 2 passed with about 60 percent of the vote. Outgoing Idaho Gov. Butch Otter and other Republican lawmakers in the state support the expansion, and Gov.-elect Brad Little, a Republican, says he will implement the initiative.

Overall, Idaho’s Medicaid expansion will provide coverage to around 91,000 Idahoans and cost the state $150 million over 10 years. The expansion will benefit close to 62,000 residents in the coverage gap—those who have incomes too high to qualify for Medicaid but cannot qualify for subsidized health insurance plans on the exchange (Idaho Press, July 23, 2018; Idaho Health Plan Analysis). Prop 2 calls for the state to submit an expansion plan to the federal government within 90 days.

Elsewhere, 53 percent of voters in Nebraska approved Initiative 427, which will expand Medicaid coverage to an estimated 90,000 residents. Initiative 427 requires the Nebraska Department of Health and Human Services to file an expansion plan with the Centers for Medicare & Medicaid Services by April 1, 2019 (Ballotpedia, accessed Nov. 12, 2018).

The expansion is estimated to cost the state about $148 million over three years while bringing in $1.36 billion in federal health funding during this time (National Public Radio, Nov. 7, 2018).

Unlike Gov. Otter, Nebraska Gov. Pete Ricketts, who was re-elected for a second term during the midterm elections, has opposed Medicaid expansion in his state. However, he has said he would respect the voters’ wishes.

And in Utah, Proposition 3 passed with 53 percent of the vote, extending Medicaid coverage to around 150,000 Utah residents (The Hill, April 16, 2018; Utah Health Plan Analysis, August 2018).

Lawmakers in the state likely will be amenable to the expansion. State lawmakers first passed a partial expansion in 2016. And in March 2018, Gov. Gary Herbert signed a bill extending Medicaid coverage to more than 70,000 residents earning up to 100 percent of the federal poverty level.

Meanwhile, 53 percent of voters in Montana rejected I-185, a funding measure that would keep the Medicaid expansion running past its end date. However, lawmakers can reauthorize the expansion before it expires. Montana Gov. Steve Bullock, a Democrat, was in favor of the funding initiative.

More people than expected enrolled under Montana’s expansion, and the state is trying to contain costs. Montana’s Medicaid enrollment has increased from more than 151,400 in 2015, when the expansion began, to 267,496 as of January 2018, according to Decision Resources Group data.

Joyce Caruthers is a senior analyst for Decision Resources Group. Follow her on Twitter @JCaruthersDRG.

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