Courts allow Medicaid expansion to proceed

State officials processed 356 new applications for Medicaid Sept. 1, the first day of an expansion of the program, and another 27 individuals were approved for health care under the expansion.

“It was a very good day, with a lot of hard work by many folks, especially in the field. We also saw a significant increase in phone volume at 5 p.m. directly related to Medicaid expansion inquiries,” said Dawnell Smith, spokeswoman for the Department of Health and Social Services.

About 40,000 Alaskans became newly eligible for Medicaid Sept. 1 after the Alaska Supreme Court acted a day earlier, refusing to temporarily block the state from expanding the health care program.

Jeremiah Campbell, a spokesman for Republican leaders in the state House, said a lawsuit filed to stop the expansion will continue in court, however. More information on the new legal steps will be available later in the week, he said.

The court rulings were a big win for Gov. Bill Walker, however, who made commitments to expand Medicaid when running for office last year and then expanded the program administratively earlier this summer after the Legislature refused to pass a bill the governor introduced, although Walker had initially proposed an administrative expansion through his operating budget.

The governor praised the Supreme Court ruling, which followed a Superior Court’s refusal to issue a temporary restraining order that Republican state legislators were seeking.

“The ruling brings final assurance that thousands of working Alaskans will have access to health care. Medicaid expansion will save the state more than $100 million over the first six years, and save Alaskan lives,” Walker said in a statement.

The governor also committed, in the statement, to working with the Legislature on reforms to the program.

The Legislative Council, acting on behalf of lawmakers, sued to stop expansion. The council, comprised of House and Senate legislators, voted 10-1 in August to sue Walker over his plans.

Walker has said nearly 20,000 working Alaskans will have access to health care under expansion. State-commissioned estimates released earlier this year indicate that nearly 42,000 Alaskans would be eligible for coverage under expanded Medicaid the first year and about 20,000 would enroll.

Evergreen Economics, an Oregon-based health care consulting firm, had made the estimates in a report to the state last February. Indications so far are that Evergreen’s estimates will hold firm for this year, said Sean O’Brien, director of the department’s Division of Public Assistance. 

In his decision against a restraining order or injunction Aug. 28, Anchorage Superior Court Judge Frank Pfiffner said the Legislative Council had not presented evidence that there would be irreparable harm, one of the conditions for a restraining order, if the expansion were allowed to begin Sept. 1.

Pfiffner was also not convinced that the plaintiff legislators have a good chance of ultimately prevailing in the lawsuit, which is another condition for a restraining order.

In a court hearing Aug. 27 Pfiffner said, “In several legal opinions the Legislature’s own attorneys told the Legislative Council that it is likely to lose this case.”

The Legislative Council opinions actually said the matter was unclear. The legal issue is an interpretation of a U.S. Supreme Court decision as to whether the expansion is an “option” for the state, under which legislative approval is needed, or whether it is mandatory under the federal Affordable Care Act, in which case Walker can do the expansion administratively.

On the question of harm, state Department of Law attorneys challenged the plaintiffs that expanding Medicaid, and then voiding the expansion if the case is ultimately lost, constitutes harm.

“There has been no showing that there will be harm done,” by the expansion, said Dario Borgheson, an attorney with the Department of Law who was representing the Walker administration.

“On the contrary, there will be real benefits given to people. Some people will get health care. It might save lives, and the state won’t have to spend money to care, to prison inmates for example, that would be paid by the federal government if the expansion is allowed.”

So far, the online portal being used for applications by the Department of Health and Social Services is functioning well, said O’Brien, which handles Medicaid applications.

“Our system is fully functioning so applications are being processed,” he said.

Meanwhile, $1.5 million was allocated by the Alaska Mental Health Trust Authority to pay the required state 50 percent portion of administrative costs of the expansion, but state officials acknowledged there is no other money available if the current year’s cost exceeds $3 million, which is the state’s $1.5 million and the same amount paid by the federal government.

“There is not another pot of funds available,” O’Brien said. However, the funds allocated are expected to cover costs, he said. “The majority of administrative costs are personnel costs to process enrollment applications and payments to providers which have increased staffing. If the enrollment is higher (than expected) we will consider our options for additional administrative or electronic processing efficiencies. We do not anticipate requesting additional funding from the Mental Health Trust.”

11/24/2016 - 9:30am