Oops, no Medicaid for you! But how about some cash?

Go read Sarah Kliff’s piece about a Montana legislator who accidentally killed Medicaid expansion in the state by a mistaken vote. Oops! Embedded in it is this:

Still, Bangerter didn’t want her state to miss out on the chance to expand health insurance to some of Montana’s 176,000 uninsured residents. So she introduced House Bill 623, which would allow the state to give many low-income residents “income-enhancement” grants, which would get their income above the poverty line — and that would mean they qualify for tax subsidies on the health insurance exchange.

This is not, ultimately, what was the subject of the oops-vote last week. The legislation had evolved to a more Arkansas-like private option. But I want to talk about this income enhancement idea anyway. Would it fly?

I ask because this was my idea! No, I can’t prove it. I don’t believe I wrote it down publicly, though I might have emailed it to someone or other. (Yes, I now see that I did.) So, some questions:

  • How many other states are considering income supplementation to bring people into eligibility for exchange subsidies?
  • Would HHS have a problem with this?
  • Does it even require federal approval?
  • Is it cost effective? (Whether it is will depend on the income distribution of state residents below 100% of the federal poverty level, as well as the cost of the next considered option, e.g., expansion of Medicaid in some fashion. So, maybe a better question is, in what cases is it cost effective?)


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