States Debate Medicaid Expansion

August 15, 2013

A half-dozen states are still trying to decide whether to expand Medicaid enrollment under the new federal health care law, more than three years after the law was signed and a year after the Supreme Court gave them an easy way to opt out, says the Washington Times.

Indiana, Michigan, New Hampshire, Ohio, Pennsylvania and Tennessee (all save for New Hampshire are led by Republican governors) are still trying to iron out their intentions for the coming year, according to a decision-tracker from the Kaiser Family Foundation.

It's a nationwide debate that could linger for months and years, as undecided states weigh a tempting influx of funds from the federal government against state-borne costs down the road. Other states may revisit their decisions in future years.
The Affordable Care Act did not impose a strict deadline on states to say whether they would accept the expansion of Medicaid and the new money that comes with it.
Seeking to get as much buy-in as possible, the Obama administration has said it will allow states to opt in on a quarterly basis, since current Medicaid law allows states to adjust their plans within that framework.

The open-ended debate contrasts with states' other big decision under ObamaCare, which is whether to create state-based exchanges where uninsured Americans can buy coverage, often with government subsidies.

States could either set up the exchanges themselves or ask the federal government do it for them, but they had to make their intentions known shortly after the elections last November, because the exchanges are set to begin enrollment on October 1.
The federal government had expected most states to accept an expansion of Medicaid until the Supreme Court ruled that states could reject the new part without losing access to existing Medicaid money.
That leaves states grappling with whether potential future budget problems and possible federal strings outweigh the chance to have the federal government pay for 100 percent of expansion through 2016 and 90 percent through 2020.

Twenty-three states and the District of Columbia have opted to expand their programs, but 21 states have declined, citing opposition to ObamaCare, suspicion of Washington's promises, and state costs down the road when the federal government scales back its contribution to the program.

Source: Tom Howell, Jr., "Medicaid Expansion Quandary," Washington Times, August 12, 2013.