States must formally request extra Medicaid funding

Washington -- At least four Republican governors who didn't ask for, or who criticized Congress' extension of stimulus Medicaid funding through June 2011, will formally request their state's share of the $16 billion Congress approved Aug. 10.

Dept. of Health and Human Services Secretary Kathleen Sebelius in an Aug. 16 letter told governors that the additional Medicaid funding is "only available for your state if you request" it in writing by Sept. 24. "As a former governor and current partner with states in running Medicaid, I urge you to act," Sebelius wrote.

The requirement is aimed at Republican governors who criticized the $787 billion stimulus act in 2009 or an extension of Medicaid funding in the act that Congress adopted in August. It forces governors to publicly and proactively seek funding they may have disparaged.

The original stimulus package included $87 billion in enhanced federal Medicaid funding. That equates to the federal government boosting its contribution to state Medicaid programs by 6.2 percentage points through Dec. 31. On average, the federal government pays for 57% of a state's Medicaid program.

The $16.1 billion August Medicaid measure offers more limited support, increasing the federal share of Medicaid by 3.2 percentage points between January and March 2011 and 1.2 percentage points from April through June 2011.

Support for the additional money was widespread among most state governors, including Republicans.

Forty-two governors signed a Feb. 22 letter from the National Governors Assn. asking Congress to extend the stimulus Medicaid funding by six months, through June 2011.

Indiana Gov. Mitch Daniels is one of at least two governors who signed the letter and has since criticized the Medicaid extension. During an Aug. 8 appearance on "Fox News Sunday," he said the extension "amounts ... to asking the citizens of responsible states like ours to subsidize those places who have been more reckless. It's probably not going to help the economy."

Daniels, however, will ask for Indiana's share of the additional Medicaid funding, said Jane Jankowski, his spokeswoman.

Mississippi Gov. Haley Barbour also may be reconsidering his opposition to the additional Medicaid support. He said on Aug. 9 that Mississippi will be required to spend at least $50 million more of its own money on Medicaid in fiscal 2011 to receive its share of the $16.1 billion Congress approved in August. Medicaid requires states to match a portion of the federal funds.

"There is no justification for the federal government hijacking state budgets, but that is exactly what Congress has done," he said.

A Barbour spokesman did not respond to multiple American Medical News inquiries as to whether the governor will ask HHS for its share. However, Barbour will request the state's portion of the $10 billion in education funding approved with the Medicaid dollars, according to local news reports.

Eight Republican state governors did not sign the Feb. 22 letter, but at least three will request the additional Medicaid funding: South Carolina Gov. Mark Sanford, Ariz. Gov. Jan Brewer and Texas Gov. Rick Perry.

Perry has been one of the most strident gubernatorial critics of the Obama administration. "The health care vote had more to do with expanding socialism on American soil than it does fixing our health care finance and delivery systems," he said in March, two days before President Obama signed the health reform law. A Perry spokeswoman said Texans paid their share of taxes and should get some of that money back.

South Carolina's Sanford initially refused the stimulus package funding. But the state Supreme Court in June 2009 ordered him to accept about $700 million, mostly for education. "We really don't have a choice here," said Sanford spokesman Ben Fox.

Representatives for Utah Gov. Gary R. Herbert and Minnesota Gov. Tim Pawlenty, who also did not sign the letter, said the governors were considering their options on the Medicaid funding. But Herbert, like Barbour in Mississippi, will ask for his state's share of the new federal education dollars, Hebert spokeswoman Angie Welling said.

The Minnesota Medical Assn. urged Pawlenty to accept the Medicaid extension to help the state reduce a multibillion-dollar budget deficit expected by 2013. "The state desperately needs these funds to continue to care for Minnesotans and avoid further health care cuts," said MMA President Benjamin Whitten, MD.