Expansion of Medicaid can increase the number of Kansans with disabilities who are employed, and delivery of health care services to 150,000 more residents of the state will pave the way for gains in appropriations from the federal government common in other states, researchers said Monday.

The administrations of Gov. Sam Brownback and Gov. Jeff Colyer, who is credited for leading development of the state's privatized Medicaid system, known as KanCare, blocked expansion of Medicaid eligibility and have forfeited about $2.72 billion in federal aid tied to the program since 2014. In 2017, Brownback vetoed a bill that would have enabled the state to broaden eligibility for Medicaid.

Meanwhile, Kansas' percentage of revenue from the federal government ranked 47th in the nation — far below that of neighboring states.

Research involving the University of Kansas and partner organizations showed individuals who reported not working because of a disability declined in Medicaid expansion states. In 2013, data showed 41.3 percent of individuals with disabilities in expansion states were employed or self-employed. That number escalated to 47 percent in 2017. In the same period, the percentage of the population that reported not working because of disability dropped from 32 percent to 27 percent. Those trends weren't present in non-expansion states.

In effect, the KU Institute for Health and Disability Policy Studies viewed Medicaid expansion as an employment incentive for people with disabilities.

"The takeaway is that, over time, these changes are becoming more robust," said Jean Hall, professor of applied behavioral science and director of the KU institute. "Our argument is that, over time, those who are better able to manage their health would have a better ability to be employed."

Thirty-two states and the District of Columbia have expanded Medicaid eligibility under a law obligating the federal government to pay no less than 90 percent of the cost of expanded services. In the five-state region that includes Kansas, only Colorado has expanded. Nebraska, Oklahoma, Missouri and Kansas have not.

Colyer, who took over for Brownback in January and is seeking the GOP nomination for governor in the Aug. 7 primary, said he supported work requirements within the state's Medicaid system and opposed expansion of eligibility for Medicaid coverage under the 2010 federal law.

"I've been fighting Obamacare and its skyrocketing premiums with shrinking benefits since before it passed," Colyer said. "Medicaid expansion is not financially sustainable and it focuses on the wrong people."

Sheldon Weisgrau, with the pro-Medicaid expansion group Alliance for a Healthy Kansas, said research showed Ohio's expanded system improved the health of participants so they could be part of the workforce.

"The main reason people on Medicaid don't work is they're not healthy enough to work," said Weisgrau, who disputed the idea expanded Medicaid was unsustainable. "In fact, it is helping the state budgets of most of the states that are participating."

Based on statistics from the federal government, a Pew Charitable Trust reported 30 states saw gains in allocation of federal dollars in fiscal 2016 and a robust piece of that rise continued to be from Medicaid allocations to states that expanded eligibility.

In 2016, Kansas' share of revenue from the U.S. government declined to 23 percent, the third-lowest in the nation. Only Virginia and Hawaii had smaller percentages. Kansas' four neighboring states were above 30 percent in 2016, with a high of 37.3 percent in Missouri and a low of 30.5 percent in Nebraska.

Kansas' percentage of the budget funded with federal appropriations reached 32.5 percent in 2011, a reflection of U.S. stimulus money forwarded to states in the recession. The percentage in Kansas fell to 24.9 percent in 2013, ticked up to 25.5 percent in 2014 and declined in each of the next two years.

Senate Minority Leader Anthony Hensley, D-Topeka, said the GOP-led legislative and executive branches rebuffed expansion of Medicaid until the 2017 Legislature voted to broaden eligibility. That bill was vetoed by Brownback, and the override failed.

"They refused to accept federal funds, especially during the Obama administration," he said. "Unfortunately, Kansas taxpayers are sending money to D.C. and it's going to other states."

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