Kansas governor releases Medicaid expansion bill she says is responsive to GOP concerns

Gov. Laura Kelly revealed her latest proposal to reform Medicaid at Holton Community Hospital on Thursday, her sixth straight attempt to bolster the program. The bill, dubbed the Cutting Healthcare Costs for all Kansans Act, expands Medicaid eligibility to people who make up to 138% of the federal poverty level.

For a single adult to qualify they would have to make less than $20,120, and for a family of four they are capped at a household income at $41,400. The expansion would allow up to 150,000 Kansans eligible for Medicaid, according to the governor’s office.

Currently, Medicaid in Kansas is limited to children, caregivers of dependent children, pregnant women, elderly people, disabled people and refugees within the first eight months in the United States. It’s also limited to people making 38% or less of the federal poverty level.

Kansas is one of 10 states that haven’t opted into an Affordable Care Act program to expand Medicaid eligibility. The federal government pays for 90% of the cost from additional enrollees, compared to 61.87% reimbursement for traditional Medicaid.

How this bill is different

The biggest difference between this bill and past attempts is a work requirement, which has been a sticking point for Republican lawmakers who say it could allow able-bodied adults to abuse the system.

“Those concerns are simply unfounded. Seventy-three percent of uninsured people in Kansas are working but have jobs in restaurants, day cares, hotels — where health insurance is not offered,” Kelly said. “Regardless, we’ve addressed those concerns in this bill by adding a work requirement.”

Work requirements are exempt for full-time college students, parents or guardians of children or an incapacitated adult, disabled people, people who do 20 hours or more of volunteer work per week, people experiencing homelessness, veterans and any individual who the secretary of health and environment “determines is experiencing hardship.”

However, Kelly said the specifics around work requirements are up for negotiation among lawmakers.

Support from across the aisle

The governor called the draft a “middle road” policy, and said it was designed to address concerns from Republicans. Rep. Dave Younger, R-Ulysses; Sen. Carolyn McGinn, R-Sedgewick; and Sen. John Doll, R-Garden City, all lent their support to the bill in a news release.

Doll even traveled five hours from western Kansas to attend the event in Holton.

“Some of my fellow Republicans say this is a welfare health care plan. Well, you have to understand that you have to be working in order to get it. Secondly, it disturbs me because this is the United States, this is Kansas. If somebody needs health care, they should be able to get care,” Doll said.

He also argued that we’re already paying for the uninsured in hospitals and it spreads the cost elsewhere, a key point in Kelly’s messaging on Medicaid expansion. Doll said the hospital in Garden City gives away $700,000 worth of care a month from people using hospital services.

Rural hospitals are struggling in Kansas, and the Center for Healthcare Quality and Payment Reform reported that 58% of rural hospitals are at risk of closing.

The draft proposed is similar what came out of committee in 2020, when Kelly drafted a compromise with then GOP Senate Majority Leader Jim Denning.

“We had 22 sponsors in the senate, there are 40 senators. We had over half that wanted that bill. We never had the opportunity to vote on it,” Doll said.

After the event, Doll told The Capital-Journal that it’s impossible to circumvent leadership on this issue.

GOP leadership not on board

House Speaker Daniel Hawkins, R-Wichita, expressed skepticism that the work requirements would stand. In February 2021, the Biden administration started withdrawing Section 1115 waivers, which allow states to pursue experimental programs in Medicaid, that required Medicaid recipients work.

“While I appreciate the Governor’s newly found support for work requirements for welfare benefits, this is nothing more than smoke and mirrors because Governor Kelly most surely knows that the Biden administration has not approved any Medicaid work requirement and proactively revoked every single work requirement approved previously,” House Speaker Daniel Hawkins, R-Wichita, said in a news release.

The Centers for Medicare and Medicaid Services approved 13 work requirement waivers under the Trump administration, though only Arkansas instituted them before the Biden administration started revoking them.

“As she continues to make false promises, House Republicans will be working on legitimate ways to improve healthcare access, lower costs and address the (intellectual/developmental disability) waiver waitlist,” Hawkins said.

Kelly admitted that it'll be a tough sell to get this version of the bill passed. In response to a question from reporters, she said she does not believe GOP leadership will accept the bill as is.

This article originally appeared on Topeka Capital-Journal: Kansas governor releases Medicaid plan she says is responsive to GOP