Recount could hinder decision on Medicaid expansion funds

A lengthy recount in the governor's race could derail the Legislature's plan to let the new governor decide whether to accept federal funds to expand the Medicaid program.

DFL gubernatorial candidate Mark Dayton, who leads Republican Tom Emmer by nearly 8,800 votes, has said he would accept the funds to help pay for coverage for the state's poorest residents, but he might not get the chance. A state law passed in May requires the new governor to make the decision by January 15. Lawmakers said they didn't consider the possibility of a recount when they set the deadline.

"The thinking behind it was to give the next governor an opportunity to decide the future of this program in Minnesota," said Rep. Paul Thissen, DFL-Minneapolis, the incoming House minority leader. "It would give two weeks for the next governor to make a decision, but to make it expeditiously."

The schedule outlined by Secretary of State Mark Ritchie has the expected recount concluded by December 14. However, a move to contest those results could throw the matter into the courts and delay issuance of an election certificate. Such legal wrangling prevented Sen. Al Franken's from claiming victory over Norm Coleman until June 2009, eight months after the election.

"The thinking behind it was to give the next governor an opportunity to decide the future of this program in Minnesota."

If Dayton takes office after January 15, the Legislature could vote to change the deadline, but Republicans, who now control both the House and Senate, haven't said whether they would agree to do so. If the new governor does not accept the funds and the Legislature does not change the law, the state would not be able to enroll in the expanded Medicaid program until 2014.

The state law was the result of months of political wrangling between Republican Gov. Tim Pawlenty and DFL legislators over how to pay for health care for low-income adults without children. The state's General Assistance Medical Care program has provided coverage for these residents, but Pawlenty argued that the state could no longer afford it. DFL legislators and the Republican governor reached a compromise in May that cut funding to the program by 75 percent and restructured the way the state pays for medical services.

Months later, many patients are waiting months to receive basic medical care, and the four hospitals that have signed on to the revised program said the scaled-back payments will cost them millions of dollars a year in uncompensated care.

The federal health care law allows Minnesota and several other states to begin receiving federal funding right away to extend Medicaid coverage to these residents. Pawlenty has said that the state cannot afford to pay the matching funds required under the Medicaid expansion, and has declined to sign a letter authorizing early enrollment. However, Pawlenty agreed to grant the new governor an opportunity to decide the issue.

Like Pawlenty, Emmer has said he opposes early enrollment into Medicaid because the state cannot afford it. Emmer did not reply to requests for comment for this story. Dayton spokesperson Katie Tinucci also declined to comment.

State Rep. Tina Liebling, DFL-Rochester, plans to introduce legislation that she said would preserve the original intent of the legislation. The proposal would eliminate the January 15 deadline and instead require the new governor to make the decision within 10 days of taking office, regardless of when that occurs. She said she will ask Republican Sens. Carla Nelson and David Senjem, both of Rochester, to introduce similar legislation in the Senate. (Nelson declined to comment on the proposal and said she hasn't spoken with Liebling about it. Senjem did not return calls seeking comment.)

"I think that the Republicans, if they're fair, and if they don't want to keep playing games with this, would be amenable to passing this legislation just to make it clear that this is what should happen," Liebling said.

However, the proposal could face resistance from state Republican lawmakers, who will control both the House and the Senate in the upcoming legislative session. Senate Majority Leader Amy Koch and House Speaker-designate Kurt Zellers did not reply to requests for comment.

Bruce Gordon, a spokesperson for Pawlenty, declined to say whether the governor would sign legislation to change the deadline. But Gordon said the Pawlenty remains opposed to the early expansion of Medicaid.

"His position on early expansion is well known," Gordon said, "And I think he would be consistent with that."

Liebling said that if her effort to amend the legislation fails, it might be possible to challenge the legislation in court, using the argument that it violates the law's original intent, but she said she's hoping to avoid a protracted legal dispute.

Either way, DFL lawmakers said the process should not drag out much longer, given the state's projected $6 billion budget deficit. Thissen said the state could receive $1.4 billion from the federal government to fund early enrollment into the Medicaid program.

"This is really serious," Liebling added. "This is big money at a time of recession. When our state budget is at such difficulty, we really need to make sure of every resource available to us ... To play games with this would really be unconscionable. I'm really hoping that that will not happen."

Regardless of whether Minnesota applies for early enrollment, the federal Medicaid program will expand in 2014 to cover adults in all states under the age of 65 who make less than 133 percent of the poverty level -- now $14,404 for individuals. That means most of the current General Assistance Medical Care enrollees will likely be eligible for Medicaid. The federal coverage would allow many of the state's poorest residents to seek care from providers across the state, reducing waiting times for appointments and increasing reimbursements to hospitals and other providers.