‘Maintenance’ a potent word in Medicaid fight

Maintenance of effort.

It sounds like slogan for an auto repair shop.

Yet the term has strong implications for many of the nation’s governors, including Nathan Deal of Georgia.

A federal provision of the health care reform law, approved last year, required states to retain (“maintain”) their eligibility rules for people covered by Medicaid, the insurance program for the poor and disabled.

That bars a state from tightening its eligibility standards to remove people from the rolls of Medicaid, which is jointly financed by the state and federal governments.

The maintenance-of-effort requirement drew Deal and then-Gov. Sonny Perdue to join more than 30 other governors and governors-elect in writing a December letter to the Obama administration, asking for removal of the provision in the face of states’ big budget deficits.

Arizona Gov. Jan Brewer has taken it one step further. She has asked the federal government to waive the maintenance-of-effort requirement for Arizona. Her bid would drop Medicaid coverage for 280,000 adults. The move would save $541 million for Arizona, which faces a deficit of more than $1 billion, according to Bloomberg News.

The Obama administration, meanwhile, has embarked in a different direction in health care reform. The new law would expand Medicaid coverage to millions of Americans  beginning in 2014. So Arizona may have trouble getting the federal relief on eligibility, but the pressure from governors will be strong.

In Georgia, Deal spokesman Brian Robinson said Friday in an e-mail that ‘’at this point, there’s not a specific request’’ for a federal waiver by Georgia on the maintenance-of-effort requirement.

Some consumer advocacy groups are alarmed at the possibility of a Georgia request.

“Rolling back eligibility among those already enrolled in our state Medicaid program essentially would strip medical coverage for those who are the youngest, oldest, and the sickest within our state,” said Joann Yoon, associate policy director for child health with Voices for Georgia’s Children. “Medicaid especially is essential at a time like the present when many face unemployment, which also means a loss of employer-sponsored coverage.”

Facing the eligibility restriction, states are paring back on what they can in Medicaid, as the New York Times reports. That means changes in benefits and payment cuts to providers of medical services, sought by both Democratic and Republican governors.

Georgia’s budget plan for fiscal 2012 would remove Medicaid coverage for dental, vision and podiatry services for adults. The state’s budget also calls for a 1 percent reimbursement cut for physicians and other medical providers under Medicaid and PeachCare, the program for uninsured children. Medicaid beneficiaries will face higher co-payments, and parents of PeachCare children will face a co-pay for the first time as well.

Meanwhile, the Associated Press/Athens Banner-Herald reports that the state’s hospital tax is not bringing in as much money as had been projected. The Georgia Hospital Association recently pushed for a revision of the one-year-old tax, but swiftly took its proposal off the table when Deal expressed opposition.

The article also describes the unexpectedly small revenues from the state’s Super Speeder law, aimed at funding Georgia’s trauma hospitals.