Medicaid expansion is a win for rural health care

On Election Day, voters in Idaho, Nebraska, and Utah, approved the expansion of Medicaid. This expansion will extend health insurance coverage to more than 300,000 low-income residents. When implemented, no longer will residents earning less than 138 percent of the federal poverty level be left without insurance coverage because they earn too little to qualify for subsidies to purchase coverage from the insurance marketplace and too much to be eligible for Medicaid.

For the thousands of rural residents who currently fall in the coverage gap, this vote means they will now be able to get the health insurance they need. 

In Nebraska, the Center for Rural Affairs, coalition partners, and the state’s voters accomplished what the Legislature could not—the expansion of Medicaid coverage for 90,000 Nebraskans. Initiative 427 passed statewide by a 53 percent to 47 percent margin.

Nebraskans in the state’s rural counties have much to gain with Medicaid expansion. Of residents estimated to be in the Medicaid coverage gap, adults between the ages of 18 and 64, earning less than $17,000 a year, nearly 36 percent live in rural counties.

Even for rural residents who are employed, insurance coverage is not always a benefit offered or accessible, because of income limitations.

U.S. Census Bureau data finds a greater percentage of those employed without insurance reside in the Nebraska’s most rural counties: 12.32 percent compared to the state’s average of 11.42 percent. Expansion will provide insurance coverage for thousands of working rural residents.

Expansion will help defer a significant portion of uncompensated care costs currently shouldered by rural clinics and hospitals and ultimately passed on to consumers. For many rural hospitals, reimbursement for services provided to expansion eligible patients will help hospitals remain viable and able to provide care for all community members.

Implementation now rests in part with the Nebraska Legislature. During the upcoming session, lawmakers will determine how to fund the state’s share of Medicaid expansion. States are responsible for 10 percent of the costs of expansion. The federal government will cover the remaining 90 percent. For legislators, it will be imperative to act in an expedient manner, seek a funding mechanism that is sustainable, while also protecting funding for education, property tax relief, and other critical services. 

Passage of the initiative also requires the Nebraska Department of Health and Human Services to submit a State Plan Amendment to the federal government by April 1, 2019. Additional staffing and infrastructure are also required to effectively implement the expansion. Enrollment in this new Medicaid eligibility category is anticipated to begin in 2020.

Similar implementation efforts are required in Utah. Idaho’s ballot initiative included a pay for and enrollment will begin in April 2019.

Voters in these three states helped bring health care coverage to more than 300,000 of their neighbors. Now, it is up to state legislatures and administrations to see through this call for health care coverage.

Inset photo: Melissa Smith and her family, of Denton, Nebraska, teeter on the edge of the health care coverage gap. Medicaid expansion helps offer assurance. | Photo courtesy of Wildfire Contact