Since the Supreme Court’s decision on the Affordable Care Act was announced, states have been grappling with how—and if— to move forward with the Medicaid expansion. The Court ruled that states opting not to expand Medicaid to their childless adult population up to 133 percent of poverty will not lose their federal matching funds for their existing Medicaid populations, making the Medicaid expansion optional. States are now facing an array of complex and inter-related policy decisions concerning their next steps on the Medicaid expansion, and are looking for resources to help inform those decisions.
On July 2, 2012, the National Governors Association submitted a letter to U.S. Health and Human Services Secretary Kathleen Sebelius asking for guidance and clarity around the myriad policy decisions they now face. The letter asked about several decision points for states, including whether they will be able to phase-in an expansion to 133 percent of poverty and receive the enhanced federal match, the potential level of matching funds available to a state that already began to expand its coverage via a waiver program, and the implications for a state not pursuing the expansion. The Republican Governors Association also submitted a letter to President Obama with questions regarding the Medicaid expansion. Marilyn Tavenner, acting administrator for the Centers for Medicaid and Medicare Services (CMS) responded and underscored the fact that states do not have a deadline to decide on whether or not to pursue the expansion.
Resources of Note on the Medicaid Expansion
HealthReformGPS has a detailed legal analysis of the Supreme Court Ruling and implications for Medicaid.
The Urban Institute recently released a brief analysis, “Making the Medicaid Expansion an ACA Option: How Many Low-Income Americans Could Remain Uninsured,” that offers a breakdown by state of the uninsured population that would be impacted by a state’s decision to expand Medicaid or not.
The Congressional Budget Office (CBO) recently completed its analysis of the impact on the cost of the ACA and the number of individuals who would remain uninsured under the law’s provisions now that states can opt out of the Medicaid expansion. Based on this new analysis, the CBO estimates that the costs of the coverage provisions of the ACA have gone down by $84 billion over the next 10 years, from 2012–2022. CBO also estimates that 3 million fewer people will have insurance coverage now that the expansion is optional for states. Visit the CBO’s website for more details of their analysis.
