Over the last several years, the Colorado Medicaid program has expanded significantly. This is something that the state has worked hard to achieve, as it’s a means for insuring a chunk of the uninsured population that cannot afford private health insurance but was previously not eligible for Medicaid coverage. Last year, the state began collecting fees from hospitals to generate funds to help pay for expanded access to Medicaid and CHP+. In addition, Colorado was one of 15 states to receive a CMS grant last year (to help fund the state’s Medicaid program) thanks to the state’s efforts to expand Medicaid.
Although the expansion of Medicaid has helped to insure more people in Colorado, it’s not without criticism. Colorado’s House Republican leaders are uncomfortable with the federal Medicaid mandates that encourage states to “…expand their Medicaid programs in perpetuity.” They have sent a letter to US Senator Mark Udall (D-Colorado) expressing their concerns with the structure of federal Medicaid mandates that they view as financially unsustainable. They do have a point. The expansion of Medicaid is a very good thing for people who are struggling to afford health insurance in the private market. But paying for the Medicaid program does take up a growing chunk of the state’s budget. The letter notes that Colorado’s Medicaid population has increased by 101% in the last decade, while the state’s population has only increased by 16% in that time.
Although Medicaid is managed by the individual states, it’s jointly funded by state and federal government money, and in order to receive the federal funds, states have to comply with certain federal Medicaid mandates. The Colorado House Republican leadership would prefer to not have strings attached to the federal money, in order to allow the state to “…craft our own program to meet the unique needs of our citizens most in need.”
There is definitely some merit to the idea of allowing states more flexibility in terms of how they design their Medicaid programs. One-size-fits-all rarely works, and each state has unique needs and goals. But health insurance coverage is an area in which Colorado struggles: although we’re a relatively healthy state, the percentage of residents with health insurance coverage (especially children) is lower than many other states. The letter requesting an end to the federal Medicaid mandates notes that “the Department of Health Care Policy and Financing predicts that by 2020 there will be 339,200 more Coloradans enrolled in Medicaid than there were in 2010.” and acknowledges that “… the challenge of meeting these obligations is significant and real…” But questions need to be asked in terms of what specific plans our elected officials have for reducing the number of uninsured Colorado residents. It may very well be that the federal Medicaid mandates are not the best fit for Colorado, but one way or another, we have to address the fact that so many people in our state are without health insurance coverage. Programs like the hospital fee system help to provide funding to expand Medicaid, and are a unique state-specific solution. It’s true that we can’t just keep expanding Medicaid without figuring out ways to fund the expansion, but we also can’t ignore the needs of the uninsured population, many of whom are uninsured because of the cost of health insurance (even if they might not technically qualify for Medicaid under the current rules). Regardless of the future of the federal Medicaid mandates, hopefully the focus of the state leadership will be on finding additional ways to generate funds and increase efficiency in order to be able to provide real access to health care for as many Colorado residents as possible.