The Pew Charitable Trusts

State officials are lining up behind a Congressional proposal to provide Medicaid benefits to hurricane victims that is more expansive than the Bush administration's plan.

Ravaged by two hurricanes in less than a month, millions of residents of Gulf Coast states have fled inland, some to states as far away as Utah. Many arrived with little more than the clothes on their backs. An unknown number will stay there permanently.

Now the evacuees are seeking Medicaid coverage in their new homes.

State officials are wary of the strain new Medicaid beneficiaries could place on their states' budgets. They're urging the adoption of a bill co-sponsored by Sens. Charles Grassley of Iowa and Max Baucus of Montana, the top Republican and Democrat on the Senate Finance Committee.

The Bush administration, meanwhile, wants to decide the scope of health coverage on a state-by-state basis. It's also calling for a five-month limit on the temporary benefits. Texas has already reached an agreement with the administration following those guidelines.

A spokeswoman for the Centers for Medicare and Medicaid Services (CMS) declined to comment on the Congressional debate.

Two major organizations representing states are backing the senators' more sweeping package rather than the White House's approach.

"I've expressed to the administration our feeling that this is a cleaner, quicker, better way to deal with the issue," Arkansas Gov. Mike Huckabee (R), who chairs the National Governors Association, told Stateline.org.

Huckabee and NGA Vice Chairwoman Arizona Gov. Janet Napolitano (D) sent a letter Sept. 21 to Grassley and Baucus voicing support for the Congressional proposal, particularly an aspect that would require the federal government to pay 100 percent of Hurricane Katrina survivors' Medicaid costs. Huckabee also stressed that states accepting refugees should be paid directly for evacuees' Medicaid costs, rather than having to be reimbursed from beneficiaries' home states.

Huckabee, who visited Washington D.C. Sept. 23 to launch an initiative to promote healthy lifestyles, said his state has become home to roughly 75,000 refugees in recent weeks.

The National Conference of State Legislatures also sent a letter Sept. 22 supporting the bill.

Both organizations back that proposal, which could be voted on by the full chamber as soon as Monday, because, without it, states have no guarantee that they'd be completely reimbursed for the health coverage they provide.

"CMS doesn't have the authority to grant additional funds. It's as cut-and-dried as that," explained Matt Salo, director of the NGA's health and human services committee.

The Senate measure would also guarantee coverage for all displaced residents earning less than the federal poverty level. Medicaid usually only covers low-income people in certain categories: children and their families, the disabled, blind and elderly.

Salo said broader coverage is needed, because states are offering health care to all of the hurricane victims.

"They're not checking to see what categories people are in or asking to see documentation that doesn't exist any more. If people need health care, they're giving it to them," he said.

"They're doing the humanitarian thing. If Congress can do the humanitarian thing and make sure that the funding is there to provide the health care, that makes sense," Salo added.

Joy Wilson, who handles health policy for the NCSL, said the bill provides states with much-needed tools to help victims. It includes funding for health care, mental health and substance abuse services, plus cash assistance through the Temporary Assistance for Needy Families program and extended unemployment benefits.

"It's a superior package of benefits ... It would help us ensure that we can provide care to the people coming into the states." Wilson said.