LANSING – With what could be the biggest policy change of the 2013-14 fiscal year, Medicaid eligibility expansion, still up in the air, legislators and officials in Governor Rick Snyder’s administration have been in discussions on developing a new strategy to convince lawmakers to agree to the proposal.

With a goal of winning approval of the concept by the end of May, officials are hoping to have an idea ready in as little as a week.

And that idea might involve something as simple as making sure members understand how the Medicaid system works in Michigan.

But it could also involve developing a concept along the lines of what the Arkansas Legislature recently adopted.

Meanwhile, a fairly intense effort on the part of supporters of the expansion seems to have begun bearing fruit, with one lawmaker, speaking on background, saying members are more receptive to the idea.

The expansion is called for under the 2010 federal Patient Protection and Affordable Care Act, labeled by critics as “Obamacare.” The bill required all states to expand eligibility to persons with incomes of 133 percent of the federal poverty limit. Under the provision, the U.S. government will pay 100 percent of the cost of the additional enrollees for three years, then states would have to pay just 10 percent of the cost over time. States could also drop out of the expansion after the first several years.

But in June 2012, the U.S. Supreme Court – in upholding the constitutionality of the act – said Congress could not compel the states to expand Medicaid eligibility.

Most states with Democratic governors, such as Arkansas, have moved to expand eligibility. Most states with Republican governors did not, most using the argument that they could not trust the federal government would keep its word on paying the increase.

In February Mr. Snyder became one of seven Republican governors calling for the expansion, saying it would both save the state money and provide greater care.

But resistance to the expansion so far has kept the issue out of the budget bills on which lawmakers have acted.

Yet the administration remains determined to see the expansion enacted, and has had ongoing discussions on how to win over lawmakers.

The solution that Arkansas reached – though it has not yet been approved by the federal Centers for Medicare and Medicaid Services – has drawn some interest. That state agreed to expand eligibility, but to use the federal money to buy private coverage for the newly eligible recipients.

While the proposal developed in the Razorback State is being studied, no one so far has proposed it for Michigan.

In fact, what administration officials and supportive lawmakers have found is that many lawmakers do not understand how Medicaid works in Michigan.

According to one administration official, speaking on background, several times lawmakers have suggested the state look at privatizing Medicaid.

“But we really do that already,” the official said.

And a lawmaker said it was clear there was confusion on the part of legislators in both the House and Senate on how the state operates Medicaid.

Michigan has done away with fee for service Medicaid operations, except in rare circumstances, for well more than a decade. Virtually all Medicaid recipients are now part of health maintenance organizations, which has helped keep costs and cost increases under better control in Michigan than in many other states.

Michigan has also been fairly aggressive in tracking down Medicaid fraud, though the lawmaker said the state can always do more to minimize the problem.

Officials hope that they will develop and implement a strategy for winning over legislators in another week, which will be necessary, they said, if they hope to win approval of the expansion by the end of May.

This story was provided by Gongwer News Service. To subscribe, click on Gongwer.Com