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Medicaid expansion plans on par with implementation date

BISMARCK -- The director of the Department of Human Services said Tuesday the state should be ready Oct. 1 to help more than 20,000 North Dakotans apply for Medicaid when the application process goes online.

But Maggie Anderson said officials won't know how many will enroll until the federal mandate requiring everyone to have health care coverage kicks in Jan. 1. The department estimates that 20,547 people are newly eligible for Medicaid.

"We have no way to predict how many people will come forward, so we will be as anxious as everyone else to see," Anderson said. "We are moving forward and are optimistic we will be able to accept applications and have coverage in place."

Anderson and other state health care and insurance leaders updated lawmakers Tuesday about the state's efforts to comply with the Patient Protection and Affordable Care Act.

The act, often called Obamacare, passed by Congress and signed into law in 2010, requires individual and small group health insurance plans to include all essential health benefits, limit consumers' out-of-pocket costs and meet multiple coverage level standards.

Under the act, a federal health insurance exchange will open Oct. 1 with multiple health care plan options for individuals to purchase.

The Affordable Care Act and recent state law also expand Medicaid coverage to provide insurance for North Dakotans under 65 who are not disabled, don't have insurance and have an income less than 138 percent of the federal poverty level.

During the 2013 session, North Dakota lawmakers required the Department of Human Services to expand Medicaid coverage to eligible enrollees until July 31, 2017, when federal match payments drop from 100 percent to 95 percent.

When the expansion kicks in, the state expects between $154 million and $171 million in federal funds to come in during the next biennium to pay for the program.

The state's share to cover the expansion for the current biennium will be about $248,789 from the general fund and about $2.9 million to $3.2 million for the 2015-17 biennium. The costs are associated with an increase in administrative oversight.

Rep. George Keiser, R-Bismarck, chairman of the Legislature's interim health care committee, said the committee's goal is to develop a broad plan to create a statewide health insurance program so when the federal funds begin to dwindle, and the Medicaid expansion program ends in 2017, the state can apply for a waiver and move to its own health care options.

"We hope to have a proposal for a concrete plan the Legislature can examine," he said about the 2015 legislative session.

Under the federal health care law, employers will be required to have affordable and accessible health care plans or face penalties.

This requirement was set to take effect in 2014, but now isn't required until 2015 after a recent decision by President Barack Obama.

Employer impact

Luther Stueland, director of health policy impact and exchanges for Blue Cross Blue Shield, spent Tuesday morning highlighting the impact the Affordable Care Act will have on North Dakota employers.

Come 2015, when the requirement does take effect, an employer with more than 50 employees can face a $3,000 fine per employee if it doesn't provide affordable health care coverage. Similarly, an employer can face a $2,000 fine per employee for all but 30 employees if it doesn't provide any health insurance.

The interim health care committee will also tackle three studies during the interim session.

The 2013 Legislature required the committee to study the health care reform options, including the implementation of the Affordable Care Act and alternatives for state-based health care reform if the federal law is repealed.

The committee also will study the immediate needs and challenges of the North Dakota health care delivery system, examining Medicaid reform, and the feasibility of developing a plan for a private health care model that will comply with federal health care reform.

Finally, the committee will study the effects of the Affordable Care Act, including alternatives to the act and the Medicaid expansion provisions to make health care more accessible and affordable.

"The committee will be going full bore from the start looking at alternatives, which is a very complicated question," Keiser told his committee.

Mike Nowatzki

Mike Nowatzki reports for Forum News Service. He can be reached at (701) 255-5607.