The Obama administration is gearing up for an influx of state requests to modify the federal-state Medicaid partnership when the nation's governors descend on the capital for their winter meeting next weekend.
High on state leaders' list of priorities is changing the healthcare reform law's Medicaid expansion
, which 26 states challenged in federal court. The issue received renewed attention last week when Health and Human Services Secretary Kathleen Sebelius told Arizona it could drop thousands of Medicaid beneficiaries without running afoul of federal law — something 33 governors have asked to be able to do.
Sebelius is under heavy pressure to work with states, which are faced with great fiscal strain and worry about the healthcare reform law's requirement that Medicaid cover everyone — even childless adults — up to 133 percent of the Federal Poverty Level. Last month, 33 governors and governors-elect wrote to Sebelius requesting that she lift the reform law's so-called maintenance of effort (MOE) requirement, which restricts states' ability to cut their Medicaid rolls ahead of the expansion in 2014.
"States are unable to afford the current Medicaid program, yet our hands are tied by the MOE requirements included in the [reform law]," they wrote. "The effect of the federal requirements is unconscionable; [they] force governors to cut other critical state programs, such as education
, in order to fund a 'one-size-fits-all' approach to Medicaid."
In a Feb. 3 letter to state governors, Sebelius outlined several solutions to the states' Medicaid woes, including increasing co-pays and cutting benefits
The looming possibility of such massive cuts
is causing consternation among healthcare advocates.