States Should Seek a Balanced Approach to Maintaining Medicaid – Say Ahhh! A Children’s Health Policy Blog

The Wall Street Journal is reporting that the nation’s
incoming Republican governors (and four of those who are on their way out) are
releasing a letter today asking Congress to dismantle the protections in the
Affordable Care Act for low-income Americans aimed at holding Medicaid and CHIP
coverage steady until health reform can be implemented in 2014.  The protection, known as the
“maintenance-of-effort” or “MOE” requirement, was one of the most important
early wins in the Affordable Care Act for low-income families and individuals. It requires states
to maintain their Medicaid and CHIP eligibility rules and enrollment procedures that were in effect on March 23, 2010 – until 2014 for adults and 2019 for
children.  (One exception is that
states with coverage of adults above 133% of the federal poverty level can
eliminate their coverage if they are facing a budget deficit.)

The MOE requirement already has been extraordinarily
effective in holding coverage steady for families losing their jobs and
job-related insurance (particularly the children in these families); seniors in
need of health and long-term care services; and people with disabilities.  Without the MOE requirement, for
example, Arizona would have entirely eliminated its Children’s Health Insurance
Program in June of 2010, and some 47,000 children would have instantly become

The Republican governors strike a strident
tone in the letter calling the maintenance-of-effort requirements “unconscionable”
because they “force governors to cut other critical state programs, such as
education, in order to fund a ‘one-size-fits-all’ approach to Medicaid.”
Frankly, if I had to use the word “unconscionable,” it wouldn’t be to describe
the plight of the nation’s governors, but rather to describe the potentially
life-threatening implications of cutting back on coverage for low-income people
when they need it now more than ever. 

tiffany tate.jpg

If anyone needs a vivid example, check out the story of Tiffany Tate in Arizona, a young woman who has battled cystic fibrosis for 26-years, largely
successfully.  She has managed to
become a high school basketball player and to become an assistant coach at Setton Catholic High School.  In September,
Tiffany was taken off the transplant waiting list due to Arizona’s decision to
deny organ transplants to Medicaid beneficiaries (an optional service which is
not protected by the Affordable Care Act’s maintenance-of-effort requirements).  Without a transplant, Tiffany
would die.  Her family started raising the $277,000 needed to privately fund
the transplant.  It is unfortunate that her family had to resort to fundraising to save her life but, fortunately for
Tiffany, publicity about her case helped them raise $200,000 and she is now back
on the waiting list.  Other Arizona Medicaid patients in need of transplants haven’t been able to raise the funds in time and have lost their lives.  Charity can’t take the place of a strong, stable Medicaid program.  Tiffany’s story underscores the need for stronger maintenance-of-effort
protections, not weaker ones.

While there is no disputing that the country’s weak
economic recovery will continue to pose major challenges to state budgets for
at least a while longer, it will be even tougher on families as they continue to face dauntingly high unemployment rates. It may take determined,
effective leadership, but states need to find a balanced way to get through the
remaining budget downturn that doesn’t involve cutting off coverage for
low-income families, seniors, and people with disabilities.  

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