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The Medicaid Expansion and the Affordable Care Act

Content provided by: Better Medicine from Healthgrades

One goal of the Affordable Care Act (ACA) is to extend healthcare coverage to poor and uninsured Americans through a mandatory nationwide expansion of Medicaid. Medicaid is the federal health insurance program for low-income families and others in need. The federal government and the states jointly fund Medicaid. The federal government sets general guidelines, but each state runs its own Medicaid program. As a result, the program varies somewhat from state to state.

Who Qualifies for Medicaid?

The expansion includes a newly eligible group of people. Previously, adults without dependent children could not qualify for Medicaid in most states. The ACA expands coverage to this group.

In addition, the income threshold under the expansion is 138% of the poverty line for Medicaid coverage. In the past, 17 states required that income be at or under 50% of the federal poverty level to be eligible for Medicaid. Based on the new poverty guidelines set for 2013, a single person earning $15,856 or a family of three earning $26,951 would qualify.

By 2022, the Kaiser Family Foundation estimates that 21.3 million more people would qualify for coverage if all states expand Medicaid. That is a 41% increase in enrollment.

Who Pays for the Medicaid Expansion?

According to the Foundation, the federal government will bear most of the cost for this expansion. However, the effect on the states varies. Eight states would see savings from the expansion by 2022. About half the states would see a minimal increase in Medicaid costs, and about half would see an increase in costs of up to 11%.

More than half of the states sued the federal government over the Medicaid expansion and its effect on their budgets. The ACA would have allowed the federal government to cut all Medicaid funding to states that did not expand the program. Their challenge to the constitutionality of the expansion went to the U.S. Supreme Court.

The Supreme Court Ruling

In June 2012, the U.S. Supreme Court ruled that states could choose to opt out of the Medicaid expansion. This allows the states to decide whether or not Medicaid expansion makes fiscal sense for its citizens. States that choose to expand Medicaid will receive enhanced funds from the federal government.

A State-by-State Decision

As of September 16, 2013, 25 states and the District of Columbia have agreed to expand Medicaid. This is according to a status tracker from the Kaiser Family Foundation. Keep in mind that this information may change, so visit the status tracker for the most up-to-date information about your state. In these jurisdictions, people with income up to 138% of the poverty line will be able to apply for Medicaid in 2014. States include:

·        Arizona

·        Arkansas

·        California

·        Colorado

·        Connecticut

·        Delaware

·        Hawaii

·        Illinois

·        Iowa

·        Kentucky

·        Maryland

·        Massachusetts

·        Michigan

·        Minnesota

·        Nevada

·        New Jersey

·        New Mexico

·        New York

·        North Dakota

·        Oregon

·        Pennsylvania

·        Rhode Island

·        Vermont

·        Washington

·        Washington, D.C.

·        West Virginia

There are 22 states that are not moving forward with the Medicaid expansion at this time:

·        Alabama

·        Alaska

·        Florida

·        Georgia

·        Idaho

·        Indiana

·        Kansas

·        Louisiana

·        Maine

·        Mississippi

·        Missouri

·        Montana

·        Nebraska

·        North Carolina

·        Oklahoma

·        South Carolina

·        South Dakota

·        Texas

·        Utah

·        Virginia

·        Wisconsin

·        Wyoming

This leaves three states that are still debating whether they should expand Medicaid:

·        New Hampshire

·        Ohio

·        Tennessee

1. Status of State Action on the Medicaid Expansion Decision, as of July 1, 2013. Kaiser Family Foundation. http://kff.org/medicaid/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/ Accessed Sepptember 24, 2013.

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