The Dispatch’s Laurel Andrews wrote about what has been on the top of the minds of people who think about such things: Is it possible for Gov. Bill Walker to fulfill his campaign promise to immediately expand Medicaid given the numerous problems with the state’s Medicaid billing system? Taking the issue further, can Walker expand Medicaid-which would most immediately affect about 40,000 Alaskans–without legislative approval, and if he tries, what kind of repercussions might that have?
The answer to the first is no, according to Val Davidson, the new commissioner of the Department of Health and Social Services. According to the Dispatch article, the Medicaid billing system needs to be fixed lest the implementation of expansion be “sloppy.”
That’s likely to take a long time. Xerox has been working on upgrading the 25-year-old system since 2007. With Xerox’s assurances, the payment system went live in October 2013, and immediately problems ensued as a result of the 546 defects. In September, there were still 460 defects. Commissioner Davidson told the Dispatch that currently, there are 324 defects. All of which means that each month, tens of thousands of claims still aren’t being processed, and providers aren’t getting paid appropriately.
But even if the system were up and running, it’s still unclear if Walker needs legislative approval before expanding Medicaid. A legislative legal opinion indicates that Walker could take executive action, but the Legislature would need to appropriate any commensurate funds. Even though the feds have agreed to pay 100 percent of expanded cost of coverage through calendar year 2016, there will likely be other costs associated with implementation.
And then there’s the political question: Even if he could expand Medicaid with a snap of the finger, would it be smart to do so without legislative buy in? And is buy-in even possible?
Sen. Mike Dunleavy, who will be sitting on the Finance Committee, has to be convinced, he said. He also said that it would be “wise” of the governor to hear the Legislature’s concerns.
“We all believe that everyone should have good health care and that everyone should have access to good healthcare. Does Medicaid expansion do that? Are we going to be creating more problems? I’m doing my research,” Dunleavy said.
Sen. Peter Micciche echoed Dunleavy’s sentiment. “Conceptually I think we can get there, but I’m still carefully evaluating any potential hidden liabilities for the state,” he said. “There are obviously challenges and concerns that the last administration had that haven’t vanished.”
House Finance Co-Chair Mark Neuman, who’s meeting with Walker on Tuesday, says that he thinks that the Legislature and the governor can work together on expansion. In the last few years, Neuman has been in charge of DHSS’s budget and has been immersed in DHSS issues. He thinks that Alaska might be able to expand it in a way that works for the state.
“I don’t think it’s going to be as big of a boogeyman as some might think it is,” Neuman said.
It sounds very reasonable, and it might end up being that way. However, one thing that nobody brought up that will likely be a big struggle is the abortion issue that’s attached to Medicaid expansion.
Alaska’s state Supreme Court has made it clear that if Medicaid is going to pay for births, then it also must pay for medically-necessary abortions. Last session, the Legislature passed a law clarifying “medically necessary,” which might have ameliorated anti-abortion objections to expansion. However, the court system has ordered that the law be put on hold pending a challenge by Planned Parenthood of the Great Northwest.
According to the state’s Bureau of Vital Statistics, roughly 550, or 38 percent of the reported 1,450 abortions performed in the state in 2013 were paid for by Medicaid.
Contact Amanda Coyne at email@example.com