This past Tuesday, it was my pleasure to speak at the Ethics Committee Brown Bag Workshop at Children's Mercy Hospital in Kansas City. This is a wonderful facility, perched right near the border between Missouri and Kansas. As Children's Mercy's own website notes:
Medicaid covers 32 million children nationwide. 163,000 children are covered by Medicaid in Kansas and 414,000 children are cover by Medicaid in Missouri. The Medicaid program is extremely important to Children’s Mercy as approximately 50% of our patient population is covered by Medicaid.
In that context it was probably inevitable that any discussion of health care reform was going to eventually get around to questions about Medicaid in general and Medicaid for children, in particular.
Children are historically a favored Medicaid population. Single adults without children are historically a disfavored Medicaid population. And there we have it, those deemed among the most sympathetic combined in an expansion program with those deemed among the least sympathetic. One of the boldest strokes in the ACA is this push to expand Medicaid away from categorical as well as financial and medical eligibility.
But the decisions by the states whether or not embrace this potentially radical transformation of Medicaid are, of course, ongoing. And, it is no accident that waiver negotiations — to the limited extent they are made public — have been circling around the desire to re-introduce categorical eligibility for the ACA Medicaid expansion population, albeit under a different name.
Consider, for instance, Arizona's soon to be filed waiver request to set a five year life-time cap on the receipt of Medicaid for "able-bodied" adults. Categorical eligibility redux?