Kansas lawmakers anxiously awaiting the governor's imminent unveiling of a Medicaid expansion plan received a crash course Monday in current cost and enrollment figures.
Kari Bruffett, vice president for policy at the Kansas Health Institute, said the impact of Medicaid on state budgets is slowly but steadily growing. In an appearance before the Senate Public Health and Welfare Committee, she reviewed income thresholds and costs for various groups served by KanCare, as the Medicaid program is known in Kansas.
She also said KHI, a nonpartisan research organization, is finalizing an updated study of how many people would be impacted if eligibility requirements were expanded under federal guidelines, and what the net cost would be for the state's general fund. Last year, KHI estimated 95,000 adults and 45,000 children would gain access.
Medicaid serves disabled, elderly and low-income residents. Right now, parents for a family of four must earn less than 38 percent of the federal poverty level — $9,538 — to qualify for coverage in Kansas. Assistance for children, including food stamps, is available for a family of four making less than $60,000.
As of 2018, KanCare served 416,476 people for a cost of $3.67 billion. Bruffett said children, parents and pregnant women amount to 74 percent of those currently enrolled in Medicaid but account for just one-third of the cost. People with disabilities and seniors with long-term care needs have a higher financial toll.
On average, a child receiving Medicaid costs $3,247 per year, and food provided by the Children's Health Insurance Program costs $2,206 per individual.
For pregnant women, who are eligible if they make less than $43,000, and low-income parents, the average cost is $6,901 per year. The average annual cost for seniors is $16,202, and the state pays $25,814 per year for those with disabilities.
Across the country, Bruffett said, states spend 19.6 percent of their budget on Medicaid and CHIP, and Kansas is in line with the average. That figure has risen from 19.2 percent in recent years, sparking discussion by some states of adopting a block grant approach.
The grants effectively would provide a cap for the state's yearly Medicaid expenses.
"There's a lot of risk in those," Bruffett said, "but some states are looking at that because they see the potential for flexibility and the potential to manage cost growth in the future."
Gov. Laura Kelly wants to expand Medicaid eligibility to adults who make up to 138 percent of the federal poverty level, which would be $16,000 for an individual or $34,000 for a family of four. Under the Affordable Care Act, the federal government covers 90 percent of the program costs as an incentive for states to expand.
In her state of the state address, Kelly said she would reveal her plan for expansion by Kansas Day, which is Tuesday.
"I can imagine no better way to celebrate our state’s 158th birthday than by embracing a policy that will make every Kansas community healthier, stronger and more secure," Kelly said.
Her budget proposal estimates a $14.2 million impact on the state general fund for the first 6 months of implementation.
That is in line with estimates from the Kansas Hospital Association and previous legislation that expected a $26 million cost for fiscal year 2020.
KHI previously predicted the total state cost would be $123.4 million before accounting for offsets — the money saved on existing coverage by unlocking federal funds. Bruffett said a revised estimate would include offsets, providing a better look at the general fund impact.