BISMARCK - With uncertainty looming over the fate of a major federal health care law, North Dakota lawmakers are weighing their options over the Medicaid expansion program that's set to expire later this year.
Medicaid expansion is available to adults younger than 65 with household incomes of up to 138 percent of the federal poverty level. As of September, there were 19,358 North Dakotans enrolled in Medicaid expansion, a cornerstone of President Barack Obama's signature health care law, the Affordable Care Act.
When the state Legislature authorized the program in 2013, it included a sunset clause of July 31, 2017. Former Gov. Jack Dalrymple's final executive budget proposed removing the sunset clause, effectively extending Medicaid expansion indefinitely. Mike Nowatzki, the spokesman for Gov. Doug Burgum, said the new governor believes there are benefits to the expanded Medicaid program in North Dakota.
"He is open to reauthorizing Medicaid expansion and believes it's important for the state Legislature to have that debate," Nowatzki said in an emailed statement.
Senate Majority Leader Rich Wardner, R-Dickinson, pointed to some uncertainty over the Affordable Care Act, commonly known as Obamacare, as one reason legislators may choose to pass a short-term extension of Medicaid expansion.
"We're probably going to do it for the next biennium," he said Wednesday, Jan. 11.
President-elect Donald Trump said Congress must repeal the Affordable Care Act quickly and pass another health care law, according to a New York Times report this week.
Rep. Marvin Nelson, D-Rolla, said he didn't see any point in another sunset clause. If the federal government does away with the program, the point would be moot, he said.
Nelson said Medicaid expansion is important to critical access hospitals in North Dakota.
"My local hospital in Rolla, they tell me they're 90 percent Medicare/Medicaid," he said. "They can't cost shift."
Fifty-eight percent of the Medicaid expansion enrollees are in rural areas, according to testimony given Wednesday by Maggie Anderson, the interim executive director of the North Dakota Department of Human Services.
House Majority Leader Al Carlson, R-Fargo, said lawmakers need to study the Medicaid expansion program further and track what happens in Washington. And with a number of federal regulations passed during the Obama years that could be on the chopping block, Carlson said he'd like to save 10 days of the legislative session in case lawmakers need to come back to Bismarck to respond. The state Constitution says the Legislature can only meet in regular session for 80 days every two years, but the governor may call lawmakers back.
"If they're talking short-term extension and giving us the option to deal with it if there's a change in the federal law, then maybe we should go (in) that direction," Carlson said. "We're kind of in a wait-and-see mode."
Up until Jan. 1, the federal government covered the full cost of Medicaid expansion, but that has since dropped to a 95 percent share. The federal contribution will continue to decline in the next few years before it reaches 90 percent in 2020.
Under Dalrymple's budget, the state is projected to spend $30.5 million from the general fund in the 2017-2019 biennium on Medicaid expansion, Anderson said.
In her testimony to lawmakers, Anderson outlined a proposed change to the Medicaid expansion program that could save the state roughly $650,000 in general fund dollars in the 18 months after Jan. 1, 2018. That would involve administering the program the same way it handles traditional Medicaid. The state's contract with Sanford Health Plan, which administers the health care coverage for the Medicaid expansion program, would then expire at the end of 2017, Anderson said.