States' efforts to customize their Medicaid expansion efforts could complicate reform

Some conservative states have won concessions from the administration in exchange for moving forward on expansion, and other states are carefully weighing those choices.

California Healthline: More States Are Exploring Alternative Medicaid Expansion Plans. What Does That Mean For Health Reform?
Pennsylvania's now in. Indiana might be next. Is the tide turning on Medicaid expansion? Recent moves by previously entrenched states indicate that might be the case. However, what does it mean for Medicaid nationwide when more states are choosing alternative plans? The Affordable Care Act calls for Medicaid to be expanded to cover residents with annual incomes up to 138% of the federal poverty level and eliminates categorical eligibility. However, a Supreme Court ruling in 2012 made it optional for states to participate in the expansion. Some states that have been hesitant to increase program eligibility under the law now are looking at alternative ways to expand health coverage to low-income residents (Stuckey, 9/17).

However, Medicaid programs are also under review in states that are not expanding.

New Orleans Times-Picayune: Lawmakers Call For More Complete Information On Medicaid Privatization Program Going Forward
Lawmakers told officials with the Department of Health and Hospitals on Wednesday they needed to provide more complete information going forward about Bayou Health, Gov. Bobby Jindal's Medicaid privatization program. The Legislative Audit Advisory Council heard testimony from DHH and the Legislative Auditor's Office about an audit that raised a number of questions about the program. Auditors testified 74 percent of the transparency report was based on self-reported data with no corroborating documentation. ... A law passed in 2012 asked for the report to see if the state was saving money by switching from the old Medicaid system to Bayou Health. DHH claims it saved the state about $136 million during the 2013 fiscal year, but the audit could not verify that information (Avery, 9/17).

AL.com: Alabama One Of Three States Picked By National Governors Association For Medicaid Reform Program
The National Governors Association has chosen Alabama as one of three states to take part in a year-long policy academy on Medicaid reform. Gov. Robert Bentley's office announced that Alabama was chosen, along with Nevada and Washington. State Health Officer Don Williamson will lead a team of six who will meet with NGA staff and other experts about Alabama's proposed regional care organizations (Cason, 9/17).