Category Archives: Medicaid/Medicare

Privatization Is Changing America’s Relationship With Its Physical Stuff

Source: Brian Alexander, The Atlantic, July 12, 2017
 
… As vague as Trump’s pronouncements have been on the matter, it is clear that the general thrust behind the promised building-and-repair push involves using federal dollars as up-front investment to entice private enterprises to provide most of the financing. While Democrats announced their opposition, the general idea of increased privatization of infrastructure has had a bipartisan cast. President Obama supported a plan to create an “infrastructure bank” that would help finance so-called public-private partnerships (known, for their alliteration, as P3s), but that idea fizzled under the glare of Republican opposition. He also floated the idea of selling off the Tennessee Valley Authority. …

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Selling Back To The Public What It Already Owned: ‘Public-Private Partnership’ Shark Bait
Source: Mercedes Schneider, Huffington Post, June 12, 2017
 
Today, I read two articles centered on this idea, both of which concerned Vice President Mike Pence – and one that concerned Pence’s role in the aftermath of Hurricane Katrina.  One article also included a sprinkling of US secretary of [privatized] education, Betsy DeVos.  A major goal of corporate education reform is to deliver public education to private entities (corporations, or even nonprofits, but don’t think that an entity termed “nonprofit” cannot be a handsome money dispenser for those running the nonprofit and doling out contracts). However, the extreme-right-Republican aim does not end with public education but with delivering the operation of the entire American infrastructure to private entities.  In the end, what this entails is having private corporations front money to state and local governments in order to lease back to the public what the public already owns.

How President Trump Might Carry The Torch Of Privatization
Source: Here & Now, WBUR, May 8, 2017

… Now President Trump is poised to continue privatization and private contracting in all kinds of industries, from education to incarceration. Here & Now’s Jeremy Hobson looks at the history and politics of privatization with Donald Cohen and Shahrzad Habibi of the group In The Public Interest. …

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Feds stop requiring bi-weekly Kansas reports on Medicaid

Source: Associated Press, July 12, 2017
 
Federal officials are no longer requiring Kansas to file bi-weekly reports on a large backlog of applicants for the state’s privatized Medicaid program.  The Kansas Department of Health and Environment was notified last week by the Centers for Medicare and Medicaid that the state can discontinue the reports it has been sending since early 2006. At the time, Kansas had more than 7,000 backlogged applications that had been pending for more than 45 days for its Medicaid program, called KanCare. …

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Kansas House fails to override Brownback Medicaid expansion veto
Source: Hunter Woodall, Kansas City Star, April 3, 2017
 
The Kansas House failed by a narrow margin Monday to override Gov. Sam Brownback’s veto of a bill that would expand Medicaid to thousands of low-income Kansans.  Lawmakers voted 81-44 to override the governor’s veto, three shy of the total needed to pass the bill without his support.  That effectively ends the Medicaid expansion push in Kansas after it passed out of both chambers with Republican and Democratic support earlier this year. … The legislation vetoed by Brownback would have expanded KanCare, the state’s privatized Medicaid program, to roughly 150,000 people in the state. …

Brownback Vetoes Medicaid Expansion in Kansas
Source: Russell Berman, The Atlantic, March 30, 2017

Governor Sam Brownback of Kansas on Thursday vetoed legislation expanding Medicaid passed with Republican majorities in the state’s House and Senate. Supporters of the bill are likely a few votes shy of the two-thirds majority needed to override Brownback’s veto. The move was expected, since Brownback has opposed expanding Medicaid for years. But the expansion effort could find new life if the governor leaves office before his term ends next year; President Trump is reportedly considering an appointment for Brownback as U.N. ambassador for food agriculture, a posting that would take the one-time presidential candidate from Topeka to Rome. …

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Hundreds of millions of taxpayer dollars on the table in closed-door Medicaid haggling

Source: Tony Leys, Des Moines Register, July 3, 2017

The three companies running Iowa’s $4 billion Medicaid program contend they need millions more dollars from taxpayers, starting this month — but there’s been no public hint of how much more money the state will have to fork over. Iowa hired the companies last year to manage the state’s Medicaid program, which covers health care for about 600,000 poor or disabled residents. The shift has been intensely controversial, with critics complaining it has led to tangles of red tape for care providers and cuts in services for Medicaid recipients. Supporters, including Gov. Kim Reynolds, say the new system is saving money for the state by leading to more efficient, effective care. …

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Disabled Iowans, fed up with cuts under privatized Medicaid, sue Gov. Reynolds
Source: Tony Leys and Jason Clayworth, Des Moines Register, June 13, 2017
 
Iowa’s roiling controversy over its for-profit Medicaid management spilled into federal court Tuesday when six Iowans with disabilities filed a lawsuit against Gov. Kim Reynolds.  The lawsuit alleges that the state’s chaotic shift to a privately run Medicaid program is depriving thousands of Iowans with disabilities the legal right to live safely outside of care facilities. The suit holds Reynolds and her human services director responsible for the private management companies’ actions. …

Complaints about Iowa’s privatized Medicaid are spiking
Source: Jason Clayworth, Des Moines Register, May 9, 2017
 
Centered largely on allegations of terminated or reduced health services, complaints about Iowa’s privatized Medicaid program have spiked in recent months, according to information presented to state officials Tuesday.  State quarterly reports show grievances and appeals filed with the three companies managing Iowa’s Medicaid program have spiked by almost 270 percent — from 343 to 1,268 — in the latest three-month report published in March. …

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Paul Ryan Still Talking Up The Idea Of Privatizing Medicare

Source: Tierney Sneed, Talking Points Memo, May 12, 2017

House Speaker Paul Ryan hasn’t let go of his cherished idea of privatizing Medicare and in an interview with a local Wisconsin radio station Friday, suggested that a blueprint for overhauling Medicare would advance in the Budget Committee again this year. … Ryan has released various versions of his so-called “Path to Prosperity” budget blueprint that have included a privatization of Medicare. The general idea he has promoted is turning Medicare into a so-called “premium support” system — i.e. a voucher system — in which seniors would get a set amount of money to shop around for private health care plans. Earlier versions of his proposal would have lead to a phase-out of Medicare altogether. Some experts have argued that even the most recent iteration of his blueprint, which ostensibly leaves some form of traditional Medicare available, would eventually lead to its phase-out as well. … It’s not just Ryan that’s trying to make Medicare privatization happen. Trump’s Office of Management and Budget Director Mick Mulvaney, a former House member with a reputation as a budget hawk, said last month that it was his “guess is the House will do either that or something similar to that.” …

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Trumpcare Will Be A Gold Rush For Private Contractors
Source: Donald Cohen, Huffington Post, March 16, 2017

… What the bill would do to Medicaid, the health care program for poor, elderly, and disabled Americans, plays right into the hands of private contractors looking to score big on taxpayer money. By including Medicaid “block grants,” which is a fancy way of saying “cuts,” the bill would force states to slash costs. And when budgets are tight, corporations come calling, claiming they’ll do the work cheaper, better, and faster. But, whether it’s running private prisons or operating water utilities, their claims often ring hollow, especially when it comes to helping those on the margins of society. Just look at what happened to cash assistance for families with children, known as “TANF.” After the program was block granted in 1996, a cottage industry sprung up to squeeze profits from the limited pool of welfare funds. Within five years, over $1.5 billion in taxpayer dollars meant for poor families had gone to contractors like IBM and Lockheed Martin. By 2014, only 26 percent of TANF dollars were going to basic assistance for poor families. … Over 60 percent of nursing home residents and two in five kids in the U.S. rely on the program. It’s also the main public funding source for family planning, like contraceptive counseling and care, and screenings for sexually transmitted infections and cancer.

… The struggle to protect Medicaid, let alone expand it, will only get tougher. On Wednesday, the Senate confirmed Seema Verma, a private health care consultant, to lead the agency in charge of the program. Verma supports block grants and has helped a number of states, including Iowa, privatize their Medicaid programs. Less than a year in, Iowa’s privatized program is spinning into disaster for 600,000 poor, elderly, and disabled Iowans. If Trump wanted somebody who knows the corporate takeover of Medicaid in and out, he certainly found her. While helping Indiana overhaul its program, Verma was also on the payroll of one of the state’s largest Medicaid vendors, Hewlett-Packard. …

Senate confirms Trump’s Medicaid, Medicare pick
Source: The Hill, March 13, 2017
 
The Senate voted to clear Seema Verma to lead the Centers for Medicare and Medicaid Services under President Trump.  Verma was confirmed in a 55-43 vote Monday evening. She will now be dropped into the fight over how to repeal and replace the Affordable Care Act and is expected to play a large role in any attempt to reform either Medicare or Medicaid. … Democrats largely said they opposed Verma’s nomination after trying unsuccessfully to pin her down on a number of policy issues during her confirmation hearing, including if or how she would reform the programs.

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Lobbying ramp-up precedes mental health funding proposal

Source: Justin A. Hinkley, Lansing State Journal, April 27, 2017

Physical health insurers ramped up lobbying operations and far out-spent their behavioral health counterparts in the months before lawmakers pulled an about-face on who should manage billions of Medicaid dollars for mental health services. Community mental health groups and allied advocacy groups spent about $52,400 on lobbying in 2016, nearly $8,700 more than their average from the previous three years, state records show. That happened as they fought to maintain management of Medicaid money for behavioral health. However, lobbyists for the private insurers who currently manage Medicaid dollars for physical health spent a combined nearly $838,000 last year, about $21,000 more than their previous three years’ average as they seek to take over the mental health dollars. … That ramp-up happened as lawmakers and Gov. Rick Snyder’s administration changed positions on the Medicaid issue — to the benefit of the physical health insurers. In February 2016, Snyder called for the private health management organizations who oversee physical health spending to also take over mental health money by Oct. 1, 2016. Lawmakers denied that proposal and instead asked the administration to study the issue and make recommendations by spring 2017. The administration did that last month, changing its position from 2016 and calling for the two funds to remain under separate management. Last week, however, lawmakers in the Senate advanced a budget proposal that would give the mental health money to HMOs by 2020. …

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Health chief Nick Lyon: I was responsible for budget language to shift mental health funding
Source: Jay Greene, Crain’s Detroit Business, October 27, 2016

Embattled Director Nick Lyon of the Michigan Department of Health and Human Services faced behavioral health leaders Tuesday and acknowledged he was the one who made the decision to insert controversial language that would have privatized mental health funding into Gov. Rick Snyder’s 2017 proposed budget earlier this year. The budget language, known as Section 298, called for the privatization of the $2.4 billion public mental health system under the management of managed care organizations that would contract with the state, ignited a firestorm of opposition among mental health officials, advocates, providers and families of the affected 300,000 patients and clients. While replaced this summer with more inclusive wording that requires the Department of Health and Human Services to issue a report with recommendations to the state Legislature in January on how to improve integration between the parallel physical and behavioral health systems, the Section 298 process created a rift and air of distrust and uncertainty between mental health officials and state government. …

Lessenberry: Privatizing Michigan health care
Source: Jack Lessenberry, Windsor Star, September 27, 2016

This is a story that hasn’t gotten major attention, but which is deeply worrying those who work with the mentally and developmentally disabled in Michigan: They fear the Snyder Administration wants to partly or totally privatize mental health services in the state. … The governor has long been a fan of privatizing services, and their fears mushroomed after an early draft of the governor’s fiscal 2017 budget called for privatizing the $2.4 billion public mental health system. That hasn’t happened yet. But the state does seem to be moving in that direction. Last month, a number of mental health advocates walked out of a meeting with state officials on how to coordinate mental health service services and payments. They had worked hard this spring to come up with a set of core values they believe need to be part of any new state proposal. … Hoyle said he wanted the state Department of Health and Human Services to commit in writing to support the core values they had agreed on in April, after a series of meetings between the advocates with Lt. Gov. Brian Calley. Though Calley is commonly regarded as being more conservative than Gov. Rick Snyder, he has an autistic daughter, and his participation was generally praised. However, Calley doesn’t control the legislature. The prison food scandal was bad enough. But far worse are the scandals at the now-privatized Detroit Medical Center, where the Detroit News reported last month that medical instruments are frequently filthy, and that doctors have attempted to operate with tubes clogged with old blood and bone fragments. … Additionally, he said, costs and recovery periods are much harder to quantify than, say, the average recovery time for a broken arm. “The conflict over whether to spend more dollars for a higher quality of life for the individual or provide less care for higher profits will always be present,” he said. Wayne County’s Watkins, who has a long background in government and politics as well as health care, doesn’t see privatization as necessarily an evil. “Much of the current community health system is private non-profit.” The danger, he said, lies in the threat “of a wholesale transfer of taxpayer dollars for mental health services to the private, profit making insurance companies.” …

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Hospice owner sentenced to 6 years in $20 million SNF kickback scheme

Source: Emily Mongan, McKnight’s, March 9, 2017

The owner of an Illinois hospice company was sentenced to six and a half years in federal prison on Tuesday for his role in a Medicare fraud scheme that paid kickbacks to nursing homes. Seth Gillman owned Passages Hospice LLC, which grew to be the largest hospice provider in the state before Gillman was charged in 2014 with inappropriately designating nursing home residents as hospice patients and overbilling for hospice services. Gillman also was accused of paying kickbacks to nursing homes that participated in the scheme, as well as providing residents of his family’s nursing home chain, Asta Healthcare, with fraudulent hospice services through Passages. Those residents often received services for years, far beyond the six-month cap in place for federal funding for hospice services, authorities said. The family of some former Passages patients told the Chicago Tribune that employees told them their loved ones were terminally ill, when they actually weren’t, in order to move them to hospice care or the more lucrative general inpatient care, or GIP. …

$2M savings may result in $42M loss for La. Medicaid

Source: David Hammer, WWL, March 8, 2017

When former Gov. Bobby Jindal’s administration ended a $2 million debt-collection contract in 2014, nobody batted an eye. After all, the state faced a mind-blowing $1.6 billion budget deficit and welcomed any bit of spending that could be cut. But that small savings may have actually created a $42 million loss for the state’s federally funded Medicaid program over the last two years. That’s more than the $40 million the Legislature recently had to slash from the Health Department to cover yet another budget shortfall. By letting a contract with New York-based HMS expire in December 2014, the state went more than 14 months without anyone identifying and recovering money for Medicaid bills that should have been paid by third parties – like an auto insurance company on the hook for a Medicaid recipient’s health expenses after a crash, or a private health insurance plan that should have covered an illness but didn’t, instead leaving Medicaid, the taxpayer-funded payer-of-last-resort, holding the bag.

.. When Gov. John Bel Edwards took over last year, his Department of Health was facing $29 million in these uncollected third-party liabilities. And the former contractor responsible for collecting third-party liabilities, HMS, was embroiled in a trade-secret lawsuit with a competitor, Public Consulting Group Inc., which was also seeking the collection contract in Louisiana. Finally, Public Consulting Group settled the lawsuit last year and agreed to not compete with HMS for contracts for seven years. Louisiana rehired HMS under a $2.1 million emergency contract last summer. According to a state legislative audit, HMS estimated the uncollected amount of third-party liabilities at $42 million by the end of 2016, but because of the large gaps in collections work, the Department of Health couldn’t be sure of that figure. … But the audit also identified $18 million in receivables the state may never be able to recover. … There was some hope that by shifting to what’s called a managed-care payment system, the state’s Medicaid program wouldn’t need to pay a company like HMS to collect third-party liabilities; the private managed care organizations hired by the state to make Medicaid payments would take care of that duty. But a significant portion of Medicaid costs in Louisiana are still paid under the old fee-for-service model, without a private managed care organization acting as a middle man. …

Report: Privatized Medicaid program serves fewer people, costs more

Source: Brian M. Rosenthal, Houston Chronicle, February 12, 2017

The privatization of a state program that transports poor Texans to medical appointments has cost the state hundreds of millions of dollars more while serving fewer than half as many people, according to a Legislative Budget Board report that some officials tried to withhold from the public. In the five years since Texas began privatizing the management of the Medical Transportation Program, the number of Medicaid recipients using the program has dropped from 350,000 to 150,000, the number of substantiated complaints has doubled, administrative costs have quadruped and the overall per-ride cost to the public has nearly tripled, the report authors found. The privatization effort was designed to reduce fraud, and anti-fraud measures may have caused some of the drop in users. Still, the budget board found, privatization has left out thousands of people and cost taxpayers an estimated $316 million more than would have been spent if the state still was running the program. Despite the problems, and in spite of a promise to put the program out for bid again, the Texas Health and Human Services Commission recently renewed all of the contracts until 2018, the budget board report noted. The problems were caused, in part, by a sloppy procurement process, the report concluded. The Health and Human Services Commission solicited applications from companies to manage different regions of the state, but it picked several firms that its own evaluators had determined were not the best options, according to the report’s authors. …

Read the full report.

Rep. Kevin McCarthy locks the door on California Medicare activists

Source: Vergil Lewis, People’s World, January 30, 2017

Nearly 1,000 people from all over the state of California descended on the Bakersfield office of House Majority Leader Kevin McCarthy Friday to demand that he drop plans to privatize Medicare and Medicaid and instead “protect, improve, and expand” these programs that are so vital to people in his district and across the country. … Speakers at the rally included healthcare workers, patients, teachers, and representatives of several unions, including the California Nurses Association, United Domestic Workers, and United Farm Workers. Latinos were especially well represented, including patients and workers from the Clínica Monseñor Oscar Romero. … Surgical nurse Sandy Reding of the California Nurses Association reported often seeing patients who require surgery because they had to choose between putting food on the table and paying for medications or seeing a doctor. Editha Adams of United Domestic Workers (UDW), a union representing 98,000 home care workers in the state, noted that 61 percent of home care funding for seniors or others needing it comes from Medicare and Medicaid, so that any move that restricts funding or access to these programs directly threatens their clients who cannot manage without the services they provide. …

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Brown Vows to Fight to Protect Medicare from Privatization Attempts That Would Hurt Millions of Ohio Seniors
Source: Senator Sherrod Brown, Press Releae, November 30, 2016

U.S. Sen. Sherrod Brown (D-OH) today vowed to protect Medicare from privatization attempts that would erode the care Medicare provides to more than two million Ohio seniors. … “Congressman Tom Price – who has been nominated as HHS Secretary – has supported Speaker Paul Ryan’s privatization plan that would yank care away from Ohio seniors and our most vulnerable, and replace it with meaningless vouchers that will take money out of the pockets of Ohio seniors and hand it over to Wall Street,” said Brown. “This is also the same crowd that has tried to raise the Medicare eligibility age from 65 to 67. Folks like Tom Price and Donald Trump who wear suits and work in this town might be able to work until 67, but tell that to waitresses and nurses and steelworkers who work on their feet all day.” Brown also stressed the need to protect Social Security from privatization. “Soon I will be introducing a bill that will protect and expand Social Security – because we know when this crowd goes after Medicare, Social Security can’t be far behind,” said Brown. …

Democrats will hold firm against Paul Ryan’s Medicare plan, Pelosi vows
Source: Greg Sargent, Washington Post, November 21, 2016

In an interview with me, House Dem leader Nancy Pelosi argued that history might repeat itself, if House Speaker Paul Ryan — with Donald Trump’s blessing — makes good on his hints to press forward with his plans to privatize Medicare. Pelosi vowed that Democrats would remain united in the battle to stop Ryan’s plan, a goal she described as crucial to defeating it, just as unity enabled Dems to block Bush’s Social Security plan. … In that 2005 fight, Pelosi recalled, Democrats actively avoided developing an alternative plan to Bush’s. Instead, Democrats said their plan was to defend Social Security, a very popular government program.  At the time, some Democratic strategists warned against uncompromising opposition. But the gamble paid off. Observers noted that Bush’s plan sank in popularity as Dems remained unified behind a refusal to budge in defense of Social Security, a move that was widely credited with helping to put Dems on track to winning back Congress in the 2006 elections. Pelosi argued that if Republicans did try to privatize Medicare, it would afford a chance to underscore “the difference between Democrats and Republicans” at a time when Democrats are trying to regain their footing after this year’s loss. “This is such a stark difference that people know we have to be unified,” Pelosi said. … Opponents of Ryan’s plan argue that, since these voucher payments would not rise as fast as health care costs, it would merely save money by forcing seniors to pay more out of their own pockets over time. They also point out that Obamacare has already improved Medicare’s fiscal outlook. It’s unclear whether Trump will go along with Ryan’s plan — doing so would require Trump to reverse himself on his campaign promise not to touch entitlements. But Trump does not appear to care as deeply about this debate as Ryan long has, and it’s reasonable to surmise he might be willing to go along with Ryan’s plan in exchange for other things he wants. …

Paul Ryan is determined to gut Medicare. This time he might succeed
Source: Michael Hiltzik, Los Angeles Times, November 14, 2016

Bursting with the policymaking power that control of both houses of Congress and the White House gives Republicans, House Speaker Paul D. Ryan (R-Wis.) has lost no time in teeing up a favorite goal: gutting Medicare.  In an interview with Fox News Channel last Thursday, Ryan said: “Obamacare rewrote Medicare … so if you’re going to repeal and replace Obamacare, you have to address those issues as well. … What people don’t realize is that Medicare is going broke, that Medicare is going to have price controls. … There’s no secret about what specifically Ryan has in mind. He intends to replace traditional Medicare, an efficient program offering guaranteed treatment and featuring rock-bottom administrative costs, with a privatized program. Seniors would get a federal voucher to help them pay premiums charged by commercial insurance plans. Ryan calls this system “premium support.” … Ryan’s plan would do nothing to rein in healthcare costs, but would likely increase them, in part because Medicare beneficiaries would be saddled with paying not only for their care, but for the shareholder dividends and executive pay of private insurance companies. The savings Ryan touts would be illusory: They would merely be shifted from government to seniors. … Medicare faces fiscal problems, but it’s not going broke, and according to both the Medicare trustees and the Congressional Budget Office, the Affordable Care Act has in fact alleviated those problems rather than caused them. The trustees reported in 2010 that passage of Obamacare had postponed the projected exhaustion date of the Medicare trust fund by 12 years — to 2029 from 2017. Projections of Medicare spending growth have consistently come down, year after year, at least in part due to changes in the program imposed through Obamacare. The program’s fiscal situation would be “substantially improved,” the trustees said, because the ACA instituted new cost controls and provided new tax revenues for the program. Both those features would disappear if the GOP repeals the ACA, as is its intention. …

Republican States Look to Customize Medicaid Expansion, Not Eliminate It

Source: Christine Vestal, Stateline, January 23, 2017

… As Congress prepares to repeal and replace the Affordable Care Act, 14 other states with GOP governors that opted to expand Medicaid under the law may face the same reality Bevin and Hutchinson did: Taking health insurance away from hundreds of thousands of people is a complicated and risky proposition. Medicaid spending for all states was about $532 billion in 2015, with about 63 percent funded by the federal government and the rest by states. In expanding Medicaid under the ACA, Republicans in expansion states chose economics over politics, even though it meant cooperating with a law that nearly all conservatives abhor. That calculus won’t change with the transition in Washington, according to Matt Salo, who heads the National Association of Medicaid Directors.

… In upcoming legislative sessions, many GOP-dominated states are likely to preserve expansion while adding so-called personal responsibility policies that have been proposed in Kentucky and adopted in Arkansas and five other states. Those policies include monthly premiums, copays and work requirements for low-income beneficiaries. … Under the Obama administration, Arkansas, Indiana, Iowa, Michigan, Montana and New Hampshire received federal approval to expand their low-income health care programs for adults under different rules than traditional Medicaid. Arkansas, with its so-called private option, was the first state to receive federal approval for an alternative expansion plan in 2013. Instead of enrolling newly eligible adults in its traditional Medicaid plan, which serves primarily children, pregnant women and the elderly and disabled, the plan for low-income adults substituted private insurance for traditional Medicaid. A bipartisan collaboration between former Democratic Gov. Mike Beebe and the state’s Republican-dominated Legislature, the plan has managed to come in under budgeted costs while covering far more people than originally projected, said Amy Webb, a spokeswoman for the state’s human services agency. After it was approved, Iowa and New Hampshire proposed similar plans. … If the Medicaid expansion remains intact, Kentucky could be the first state to get approval for an alternative plan under the Trump administration. With enough latitude, even holdouts such as Florida, Texas and Virginia might be persuaded to accept federal money to cover low-income adults.