An Update On Medicaid Expansion Efforts and How They Affect Travelers
As we move closer and closer to November midterm elections in the U.S., healthcare access and quality issues have become a heated political battleground for legislators and citizens across the political spectrum. Medicaid expansion, a tentpole policy part of the Affordable Care Act passed in 2010, is one of the key divisive topics in this realm. It’s also something healthcare providers—and by extension travel healthcare professionals—are keeping an eye on, as expansion can have an impact on provider funding and patient care. What Is Medicaid Expansion? Under the Affordable Care Act, states can expand Medicaid eligibility to nonelderly adults with incomes at or below 138 percent of the federal poverty level, which equals about $16,700 a year for a single person and $34,600 for a family of four. Expansion states are funneled billions of dollars from the federal government to support expansion efforts and coverage for newly insured populations. In states that haven’t expanded, those adults fall into a “coverage gap” for having incomes above traditional Medicaid eligibility but below the limit to get approved for ACA marketplace premium tax credits. So far 34 states have approved Medicaid expansion, two states—Maine and Virginia—are in the works to implement expansions, and three states—Idaho, Utah and Nebraska—could potentially approve Medicaid expansion this year. Why is Medicaid expansion important to travelers? Simply put, hospitals in states that expand Medicaid can expect to see a new influx of patients looking for care on a regular basis which can affect seasonal staffing needs. A Commonwealth Fund study in 2015 found that 4 out of 10 primary care physicians who accepted Medicaid saw an increase in patients after expansion coverage took full effect. Additionally, studies have shown that hospitals in expansion states have much healthier budgets, which can leave more money on the table for hiring and retaining temporary or permanent staff. According to an analysis by the Kaiser Family Foundation, expansion hospitals saw “significantly improved hospital operating margins.” These factors don’t completely guarantee that facilities in expansion states will overflow with traveler needs, but it can help prevent razor-thin hospital budgets and get executives thinking about how to ease the burden on their permanent staff. What’s happening in states with plans for Medicaid expansion? Maine Medicaid was supposed to be available to newly eligible Maine residents on July 2, but a series of appeals and heated courtroom battles have kept expansion in limbo, leaving more than 70,000 without coverage. At the heart of the issue is Republican Gov. Paul LePage, who has vetoed Medicaid expansion efforts six times in office. Mainers approved Medicaid expansion through a referendum vote with a 59 percent voting majority in 2017, but LePage refuses to submit a plan to the federal government until sufficient state funding—under his terms—is found. LePage was ordered by a Superior Court justice to submit a plan in June, but his administration appealed the ruling to the Maine Supreme Court, saying they did not have to file a plan during the appeal process. Arguments for the appeal took place on July 18, but the court has yet to make a decision. You can view a more detailed timeline of the events leading up to the court hearing by clicking here. Idaho Advocates in Idaho successfully petitioned and gathered 75,314 verified signatures to add a Medicaid expansion measure to the ballot this November. The petition met both state requirements to qualify the ballot measure, gathering at least 56,192 verified signatures that represented at least 18 of Idaho’s 35 legislative districts, according to Ballotpedia. Utah Utah Gov. Gary Herbert signed a bill on March 27, 2018, for partial Medicaid expansion, directing the state to seek federal approval to expand Medicaid to 100% of the federal poverty level. The bill stipulated using the ACA enhanced federal match rate and adding a work requirement for the expansion population. To date, the Center for Medicare and Medicaid Services (CMS) has not approved waivers to access the match rate until Utah approves a full expansion. In the meantime, Utah expansion advocates garnered enough petition signatures to add a competing bill to November ballots that would approve a full expansion. Nebraska Similar to Idaho and Utah, Nebraska advocates have submitted a petition to add a Medicaid expansion initiative to the midterm election ballot this fall. Supporters filed more than 133,000 signatures on July 5, but the Secretary of State office is still verifying the signatures. At least 84,908, or more than 60 percent, of the signatures need to be valid for the initiative to make the ballot.
As Maine Medicaid expansion stalls, hospitals and enrollees are left in limbo
Maine’s Medicaid-eligible residents, which make up more than 70,000 people, were set to enroll on July 2 as part of the expansion plan approved by nearly 59 percent of voters last November. But after a month of battles between advocacy groups and stonewalling efforts by Gov. Paul LePage’s administration, the enrollment date has passed and hospitals are left waiting for an influx of patients and staffing needs that may not come anytime soon. “A hospital representative I work with said they all have their fingers crossed that [the expansion] gets approved and it all goes smoothly, but she agreed it is a mess currently,” said Larry Jenkins, a sales team member for staffing agency LiquidAgents Healthcare. “There are no plans for additional staff at this time.” For clarity, here’s a timeline of where Maine’s Medicaid expansion plan stands: November 2017: Maine voters approve Medicaid expansion under provisions outlined in the Affordable Care Act, making Maine the first state to approve expansion by referendum. The Maine Department of Health and Human Services is required to file a plan by April 3, 2018 April 3, 2018: No plan is filed by Maine DHHS. LePage said he would not move forward with a plan until adequate funding is approved by the legislature to support expansion efforts. April 30, 2018: Advocacy group Maine Equal Justice Partners sue Maine DHHS to force the administration to submit a plan, citing a $130 million surplus fund that could be used to fund the expansion for 2019. June 4, 2018: Superior Court Justice Michaela Murphy rules in favor of Maine Equal Justice Partners, citing a “complete failure to act” by Maine DHHS in missing the April 3 deadline. They are ordered to submit a plan by June 11. June 7, 2018: LePage’s administration files an appeal for the decision, and requests to not file a plan by June 11 while the appeal is considered. June 18, 2018: Justice Murphy denies the appeal and orders DHHS again to file a plan with the federal government. Gov. LePage’s legal team appeals the order to the Maine Supreme Judicial Court to delay the deadline while the original appeal is considered. Arguments are scheduled for July 18. June 29, 2018: Gov. LePage vetos a potential expansion funding bill. Lawmakers must decide to override or uphold the veto on July 9. July 2, 2018: Maine Equal Justice Partners encourage eligible residents to apply for Medicaid anyways despite ongoing litigation. July 9, 2018: Conservative legislators uphold the veto in an 85-58 House vote. LePage and House Republicans criticize “one-time” funding sources included in the plan, saying Maine needs a long-term funding plan. Monday’s vote on the veto of Maine’s Medicaid expansion funding bill marks the sixth time LePage has stopped expansion legislation through the use of veto during his two terms of office. The final verdict on Maine’s Medicaid expansion efforts may set the precedent for lawmakers in Idaho, Nebraska and Utah. Advocacy groups submitted similar ballot initiatives after successful petitions to let voters decide the fate of Medicaid in their states this November. Utah’s ballot initiative passed state scrutiny and was added to the fall ballot. Secretaries of state in Nebraska and Idaho are reviewing petition signatures to confirm they represent a specific percentage of voters in each state.
Travel Jobs: Top 10 States for June, July Market Predictions
In our June traveler job market predictions, we talked about the “summer stall”—less new job postings, more competition for every job and more interest in atypical summer job states. Based on StaffDNA job board data, two of our predictions were on target. Job application volume increase by nearly 20 percent from May to June, marking the most active month since January. What we didn’t expect was for supply to match pace with demand. Hospital systems in many states, including popular summer destinations like California and Virginia, bounced back after the late-May and early-June slump. Part of this can be linked to vacation plans for permanent hospital staff, according to travel agency sales staff sources. As the regular staff takes off for the summer or cuts back on hours, that provides opportunities for travelers to fill the gaps. We expect for this market momentum to stay strong in July, as travelers who took time off in June will be planning ahead for the start of the school season in August or to find a fall contract in September. The back-to-school rush marks a yearly milestone for many travelers with children or grandchildren. They will typically take a break during the summer for childcare, and return to hospitals once the kids are back in school. “The experienced travelers know it can take four to six weeks to find and start a job, so they start the search for an agency and position mid-summer,” said Kate Quinn of LiquidAgents Healthcare. Let’s take a look at what we learned from our top markets for June. Rankings barely shift as travelers settle in for the summer While April and May saw a lot of “movement” in terms of where healthcare travelers applied across the country, ranking shifts were much more conservative in June, despite the high application volume. Most states moved up or down the list by 5 ranks or less, and five states—North Carolina, Pennsylvania, Nevada, Wisconsin and Washington—didn’t move at all. We expect the list to remain mostly stable for July, August and potentially in early fall, as traveler won’t start making big moves until we get closer to the holiday season. Michigan, Missouri, Virginia enter the Top 10 For the first time this year, Missouri joined the likes of Texas, California and Florida in the top 10, moving up two spots from May to No. 9. Virginia moved back up as anticipated, jumping up five ranks to No. 10 on the list. The state is both a top travel destination for summer 2018 and one of the top five highest paying travel nurse states in the U.S. Montana, Wyoming climb the charts; Connecticut drops to dead last Montana and Wyoming both moved up seven ranks to take the No. 41 and 42 slots, respectively, while Connecticut dropped 16 spots to the bottom of our list. Connecticut has consistently ranked in the bottom half of the list for job board applications. It’s also one of the most expensive states to work in as a traveler because of the high regional cost of living and low average pay packages. Interest in Maine uncertain as Medicaid expansion remains in flux Enrollment for the voter-approved Medicaid expansion was supposed to roll out on July 2, which would have provided a $500 million shot in the arm for healthcare funding in the state and coverage for more than 70,000 eligible recipients. Pending litigation surrounding the expansion has left the issue in limbo. A Maine judge forced Gov. Paul LePage to submit an expansion plan to the federal government by June 11, but LePage’s administration submitted an appeal for the ruling. While the appeal is pending, LePage also vetoed the expansion bill this week. Because of the political turmoil, it’s uncertain whether the expansion will have an impact on the Maine traveler job market as expected. June’s Top Markets Florida California Texas North Carolina Georgia South Carolina Michigan Pennsylvania Missouri Virginia Illinois Indiana Kentucky Tennessee Arkansas Arizona Nevada Idaho Oklahoma Iowa Wisconsin West Virginia New Mexico Maine Oregon Colorado Washington Hawaii Ohio Alabama Louisiana Maryland Mississippi New Jersey Alaska Utah Kansas Montana Wyoming Minnesota Massachusetts North Dakota New York District of Columbia Delaware Nebraska New Hampshire Rhode Island South Dakota Vermont Connecticut
Maine Judge says Gov. LePage must still file Medicaid plan despite appeal
A Maine judge ordered Republican Gov. Paul LePage’s administration to file a Medicaid expansion plan despite ongoing litigation on Monday. The LePage administration made a motion on June 7 to not file a Medicaid expansion plan by June 11 while the Superior Court considers an expedited appeal, which was denied by Superior Court Justice Michaela Murphy on Friday, according to an Associated Press report. Nearly 59 percent of Maine residents voted last fall to expand Medicaid by July 2, which would provide insurance coverage to more than 70,000 adults with incomes at or below 138 percent of the federal poverty level. It would also open the state up to receive more than $500 million in federal funds to cover the new enrollees. The Maine Department of Health an Human Services missed the original April 3 deadline to file the plan and receive these funds, which was cited in the court’s June 4 ruling as a “complete failure to act.” The harm to low-income Mainers who remain without Medicaid benefits outweighs harm to LePage’s administration, Murphy told the Associated Press. “The executive branch’s refusal to act and follow the will of the people … has the potential to engender disrespect for duly enacted laws,” the judge wrote. Gov. LePage vetoed Medicaid expansion legislation five times in two terms of office, saying it will do more harm than good for the state budget and that he considers Medicaid as another form of welfare. His administration laid the blame for not submitting a plan on the state legislature, arguing that they have not found adequate funding to implement the ballot measure, without a tax hike and under LePage’s specific terms. The full cost of implementing the expansion is a disputed figure between Gov. LePage’s administration, which estimates as much as $58 million in the first year, while the nonpartisan Office of Fiscal and Program Review estimates a need of $30 million in state funds.
Judge orders Maine governor to move on Medicaid expansion
Want to know how this will affect traveling healthcare professionals? Click here to read our take on the issue. After months of uncertainty following Maine’s passage of a voter-approved Medicaid expansion effort last year, a state judge on Monday ordered Gov. Paul LePage’s administration to officially move forward with expansion plans. In her ruling, Justice Michaela Murphy of Maine Superior Court ordered the administration to submit a state plan amendment that would update the terms of its Medicaid program and submit it to the federal government by June 11. The ruling cited the “complete failure to act” by Maine Department of Health and Human Services to establish a file a plan to expand Medicaid by the original April 3 deadline. Maine was the first state to expand Medicaid through referendum, and if Gov. LePage’s administration complies by next week, more than 70,000 eligible residents will be able to enroll for healthcare coverage by July 2. It would also trigger a federal cash flow of more than $500 million in federal funds to help the state cover healthcare costs of those with yearly incomes more than 138 percent of the poverty level, which is $16,642 for an individual or $24,600 for a family of four. A spokesperson for Gov. LePage’s administration told Politico that they are reviewing the decision and declined to say if they would appeal the ruling. The court order is a big win for Maine Equal Justice Partners, a progressive group that filed a lawsuit in April to force LePage’s administration to move forward on expansion after DHHS missed the deadline, according to a report in the Bangor Daily News. Gov. LePage has staunchly disapproved of Medicaid expansion efforts, vetoing similar measures multiple times in his two terms of office saying it will burden taxpayers and the state budget. His administration laid blame on the state legislature, arguing that they have not found adequate funding to implement the ballot measure. “Now that Medicaid Expansion is the law, it is my responsibility to implement it, and I will. But until they adequately fund it, there is nothing we can do,” Gov. LePage said in a press release. “Before we can proceed with expansion, DHHS needs both the staff to implement it and the money to pay the bills that will come due when the state plan amendment is approved.” The full cost of implementing the expansion is a disputed figure between Gov. LePage’s administration, which estimates as much as $100 million a year, and the nonpartisan Office of Fiscal and Program Review, which estimated a need of $45 million in state funds. How This Affects Travelers Similar to last week’s announcement that Virginia’s lawmakers successfully passed Medicaid expansion after a five-year battle, the new stream of funding for Maine hospitals could provide a boon to travel employment opportunities in the state. Newly insured patients who may not have had access to healthcare services will flock to hospitals, which could cause a spike in temporary staffing needs. The major difference with Maine, however, is that Maine’s enrollment will begin this summer if the court’s ruling stands, whereas Virginia won’t see an influx in new Medicaid patients until next year. We’ll keep tracking this story as it develops, but keep an eye out in Maine after mid-July and in August for a potential spike in job leads.