In the two dozen states that have resisted the federal drive to expand the program that funds medical care for the poor, fierce opposition from conservative governors and lawmakers has ground the expansion effort to a crawl.
In several states such as Arkansas and New Hampshire, coalitions of expansion advocates and business-oriented Republican legislators have boosted Medicaid's rolls through the "private option" approach. This enables eligible adults to obtain health coverage through subsidized purchases of commercial health insurance policies on the recently launched individual health exchanges.
North Dakota has developed another approach. It is inviting commercial insurance carriers to bid for the opportunity to provide health coverage for the state's 20,500 newly Medicaid-eligible poor adults. State officials solicited bids last August from carriers that "had to have a policy that covered all the essential health benefits," says Julie Schwab, medical director of the state Department of Human Services.
Two commercial carriers placed bids: Blue Cross Blue Shield of North Dakota, the state's largest health insurer, and Sioux Falls, SD-based Sanford Health. While both bids were accepted, only Sanford decided to move forward with North Dakota's Medicaid expansion effort, which launched enrollment on Jan. 1.