More About Jesse Cross-Call

Jesse Cross-Call

Jesse Cross-Call is a Policy Analyst in the Health Policy division of the Center on Budget and Policy Priorities. In this role he examines issues related to the implementation of health reform and provides information and technical assistance to state and local officials, providers, and nonprofit organizations who are working on issues related to expanding coverage to the uninsured through Medicaid and the new health reform marketplaces.

Full bio and recent public appearances | Research archive at

House Bill to Extend Children’s Health Funding Would Ease Pressure on States

March 24, 2015 at 2:27 pm

The House is likely to vote this week on a bipartisan compromise to permanently fix Medicare’s flawed physician payment formula (SGR) and extend federal funding and current policy for the Children’s Health Insurance Program (CHIP) for two years.  The continued momentum for extending CHIP funding quickly and cleanly is important not only for the millions of children who rely on the program for health coverage, but also for states and their budgets.

Six state legislative sessions have already ended, and Kentucky will become the seventh when it adjourns today.  So while lawmakers have yet to make new federal funding for CHIP available starting in October, states are passing budgets for the next fiscal year — which in most states begin on July 1 — nowRepublican and Democratic governors alike have called for CHIP funding certainty and quick extension.

Each week that passes without congressional action on CHIP places states in a tougher position.  For example, a recent survey of state CHIP directors found that if uncertainty about the program’s funding persists, states will have to pursue contingency plans that reflect the risk that no new federal CHIP funding will be available, such as how to move kids out of CHIP coverage and how to inform families that coverage could end.

To be sure, it would be better if the House bill extended federal CHIP funding for four years in order to ensure longer-term stability for the program and the children it serves (and robust efforts are expected to secure that in the Senate once the House bill is passed).  Nevertheless, the House bill does right by states and kids in other critical aspects.  Most importantly, the House bill maintains program improvements that Congress made in 2009 and 2010, while leaving out proposals floated by House and Senate committee chairs last month that would likely cost many children their coverage while shifting costs to states.

Medicaid Expansion States Are Saving Money

March 16, 2015 at 1:48 pm

Health reform’s Medicaid expansion has produced significant state budget savings, two new reports covering five states show. Savings are expected to continue — and grow — in coming years. These reports provide strong evidence that claims that the expansion will harm state budgets are misplaced.

Expanding Medicaid saved Arkansas and Kentucky nearly $31 million and $26 million, respectively, in just the first six months of 2014, according to a report prepared for the Robert Wood Johnson Foundation. They expect to save $89 million and $84 million this fiscal year, which ends June 30. What’s more, the report found that these states will continue to accumulate savings that will cover all costs related to the expansion through the end of the decade, even as the federal share of those costs phases down from 100 percent to 90 percent by 2020.

Arkansas and Kentucky have achieved these savings in areas available to all states. For example, as more people have gained health insurance, fewer have needed state-funded mental health and behavioral health programs that serve the uninsured. And both states have moved people who previously received care under specialized Medicaid categories for disabled adults and women with breast and cervical cancer into the expansion’s new eligibility group, for which the federal government is paying the entire cost.

Connecticut, New Mexico, and Washington State are also enjoying budget savings from their Medicaid expansions, a separate report from the Kaiser Family Foundation found.

In addition, Arkansas, Kentucky, New Mexico, and Washington State are collecting more revenue from taxes on the providers and managed care plans that serve the newly insured, the reports show.

Do Right by States and Extend Children’s Health Funding Soon

March 2, 2015 at 12:32 pm

The Children’s Health Insurance Program (CHIP), which along with Medicaid has played a central role in cutting the number of uninsured children to a historic low, has no new federal funding starting in October.  Congress should act soon to extend CHIP — for example, by attaching a funding extension to must-pass legislation in March to avert scheduled cuts in Medicare payments to physicians.

Waiting until later in the year to fund CHIP or pursuing harmful program changes to it would make it unnecessarily difficult for states to administer their CHIP programs and risks disrupting coverage for children.

Here’s why:  State legislative sessions are already entering the homestretch; Virginia adjourned Saturday, seven more states will end by April 1, and 13 others by May 1.  This means states are making decisions now about their budgets for fiscal year 2016, which in most states begins on July 1.  As Governors Steve Beshear (D-KY) and Bill Haslam (R-TN) wrote Congress recently on behalf of the National Governors Association, “certainty of [CHIP] funding in the near-term is needed so that states may appropriately budget and plan for their upcoming fiscal years.”

The longer Congress waits to fund CHIP, the greater the unnecessary burden it will place on states.  In a recent survey, many state CHIP directors said that continued delay would force them to develop contingency plans for possible measures like moving enrollees out of state CHIP programs if federal funding runs out, updating eligibility systems to allow for the termination of coverage, and renegotiating or ending contracts with managed care plans providing CHIP coverage.

Also, if Congress pursues controversial changes that could adversely affect the program and the children who rely on it, that likely would significantly delay — and could derail — CHIP funding legislation.  Draft legislation from Senate Finance Committee Chairman Orrin Hatch (R-UT) and House Energy and Commerce Committee Chairman Fred Upton (R-MI) is a prime example.  As we’ve explained, it would likely cause some CHIP children to become uninsured, shift large costs to states, and make the program harder for eligible children to enroll in.

Congress should instead quickly extend CHIP funding for another four years and largely continue existing policies, as bills introduced by Senator Sherrod Brown (D-OH) and Representative Gene Green (D-TX) and as the President’s 2016 budget would do.

Wisconsin’s Growing Cost of Not Adopting Medicaid Expansion

February 20, 2015 at 1:05 pm

Governor Scott Walker’s decision not to adopt health reform’s Medicaid expansion will cost the state $345 million in forgone budget savings over the next two fiscal years, the nonpartisan Legislative Fiscal Bureau estimates.  That’s $30 million more than the bureau estimated in August.  (The August report also estimated that adopting the expansion would have saved the state $206 million in the past two years.)

Under health reform, the federal government picks up 100 percent of the cost of expanding Medicaid through 2016 and at least 90 percent thereafter.  To receive this special matching rate, though, states have to expand Medicaid eligibility for adults up to 138 percent of the poverty line.

Governor Walker chose instead to extend Medicaid to adults only up to the poverty line through a separate waiver, so Wisconsin receives its regular matching rate, under which the federal government pays 58 percent of the cost of covering this population.  The $345 million in projected savings reflects the higher matching rate Wisconsin would receive by adopting the full expansion.

Other states also face forgone savings if they don’t adopt the Medicaid expansion this legislative session.  In Idaho, a workgroup put together by Governor Butch Otter estimates the expansion would save the state $173 million over the next ten years.  And in Alaska, Governor Bill Walker’s administration estimates the expansion would save the state $6 million next year.

Medicaid Eligibility for Low-Income Adults Lags Badly in Non-Expansion States

January 22, 2015 at 12:51 pm

The 23 states that haven’t expanded Medicaid as part of health reform have very limited Medicaid eligibility for non-elderly low-income adults, the latest annual survey of state health program officials from Georgetown University’s Center for Children and Families and the Kaiser Family Foundation finds.  That’s a key reason why 4 million uninsured adults remain in a “coverage gap” in non-expansion states, with incomes too high for Medicaid but loo low for subsidies to buy coverage through health reform’s marketplace.

By and large, non-expansion states have kept Medicaid eligibility for low-income adults at the very low income levels in place before health reform took effect.  In the typical non-expansion state, parents only qualify for Medicaid if they have incomes less than 45 percent of the poverty line, or less than $9,000 a year for a family of three, according to the report.  And in nearly every non-expansion state, non-disabled non-elderly adults without children don’t qualify for Medicaid no matter how low their income is.  (See chart.)

By comparison, in the 27 states and the District of Columbia that have expanded Medicaid, non-elderly adults with incomes below 138 percent of the poverty line ($27,000 for a family of three) are eligible for Medicaid.

Most of the 4 million adults in the coverage gap either work or are in a family with a worker, the Kaiser Family Foundation previously reported.  Research shows that for most low-wage workers, their employer either doesn’t offer coverage or doesn’t offer coverage that they can afford.

States that have expanded Medicaid have enjoyed especially large gains in insurance coverage since health reform’s major coverage expansions took effect in January 2014.  For states like Idaho, Utah, and Montana, which are seriously considering expanding Medicaid this year and have very limited Medicaid eligibility, the Medicaid expansion offers a surefire way to achieve similar progress.