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Medicaid Expansion

The Affordable Care Act (ACA) provides the opportunity to expand access to Medicaid coverage to almost all non-elderly adults up to 138% of the Federal Poverty Level.  The federal government will fund 100% of the costs of these newly eligible individuals through FY2016, after which federal funding will phase down to 90% in FY2020 and thereafter.  In addition to expanding eligibility, the ACA also requires states to streamline eligibility and enrollment systems, allow hospitals to more promptly determine Medicaid eligibility for individuals, as well as initiate other reforms.

The Supreme Court, in June 2012, upheld the constitutionality of ACA’s individual mandate to purchase health insurance, but that same decision, as a practical matter, makes Medicaid expansion optional for states; as a result, many states have not expanded their Medicaid programs.  As of October 2017, thirty-one states and the District of Columbia have decided to expand. 

Many states have worked with the federal government to develop state-specific expansion solutions that, for example, purchase private coverage for Medicaid enrollees on the Exchanges and/or provide incentives for healthy behaviors.  And while this resolution offers coverage for many, it leaves myriad Americans without insurance.  Unfortunately, millions of low-income individuals residing in states that have yet to expand currently fall into a "coverage gap," and thus have no access to health care coverage. 

The FAH strongly supports Medicaid expansion for all states, to provide coverage to eligible Americans.  It is critical that policymakers and other stakeholders work closely in the states that have yet to expand, to encourage them to expand Medicaid so that their residents will have access to affordable health care coverage.