Medicaid Expansions

This rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children’s Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and finalizes requirements “alternative benefit plans” to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored for exchanges. A fact sheet is available.

In this report, MACPAC examines several fundamental issues including Medicaid and CHIP eligibility and coverage for maternity services, the newly implemented increase in physician payment for primary care services, access to care for non-elderly persons with disabilities, the availability of Medicaid and CHIP data that can be used for oversight and program monitoring, and improving the effectiveness of program integrity activities.

One of the major vehicles in the ACA to increase health insurance coverage is an expansion of Medicaid to adults with incomes at or below 138% of the federal poverty level (FPL). While the expansion was intended to be implemented in all states, as a result of the Supreme Court decision on the ACA, it is now effectively a state choice. As of July 1, 2013, 24 states are moving forward with the expansion, 21 states are not planning to move forward, and there is ongoing debate in 6 states. Based on an analysis of 2011 American Community Survey data, this brief examines the implications of current state Medicaid expansion decisions on coverage by race and ethnicity.

The ACA will have important impacts on state Medicaid programs, likely increasing participation among populations that are currently eligible but not enrolled. The size of this “welcome-mat” effect is of concern for two reasons. First, the eligible but uninsured constitute a substantial share of the uninsured population in some states. Second, the newly eligible population will affect states’ Medicaid caseloads and budgets.

This brief explores how state officials and stakeholders are analyzing the fiscal and macroeconomic implications of their choice about whether to expand Medicaid. It focuses on 10 of the 11 states that are participating in the Robert Wood Johnson Foundation’s (RWJF) health reform monitoring and tracking project. The discussion is divided into four sections: the legal and policy context in which states are deciding whether to expand Medicaid; the status of decision-making around Medicaid expansion in our 10 RWJF states; how the fiscal effects of Medicaid expansion are being analyzed; and how the macroeconomic effects of Medicaid expansion are being analyzed.