Medicaid Expansion

Medicaid Expansion

States that plan to expand Medicaid coverage in 2014 have lots of work to do to prepare. In many states, advocates need support in making the case for expansion. The Medicaid Expansion Center offers information on everything from the Supreme Court decision’s effect on Medicaid to news from the Department of Health and Human Services (HHS), plus the best tools for helping your state make the most of the expansion.

• General Background Information
• Tools to Make the Case for a State Expansion
• Resources from the States

You may also be interested in our new Medicaid Defense Center, featuring the latest news about threats to Medicaid funding and to the program's structure, with tools to help advocates respond to the attacks.

General Background Information  

• Premium Assistance in Medicaid and CHIP: An Overview of Current Options and Implications of the Affordable Care Act provides useful background information on premium assistance in Medicaid as states consider the option as a way to cover the Medicaid expansion population. In January, HHS issued proposed rules on this issue. (Kaiser Commission on Medicaid and the Uninsured, March 2013)


• The Financial Benefit to Hospitals from State Expansion of Medicaid (Urban Institute and the Robert Wood Johnson Foundation, March 2013)


• The Department of Health and Human Services (HHS) released its final regulations on the essential health benefits standard, which is important for the Medicaid expansion. When states develop their alternative benefit plans for people who will be covered through the Medicaid expansion, those plans must include the essential Health benefits. For more information about alternative benefit plans and how they relate to essential health benefits, see the letter to state Medicaid directors from November 20, 2012. (HHS, February 21, 2013)
• HHS Secretary Sebelius issued a letter to governors and a blog post clarifying that states can receive full enhanced federal matching payments only if they expand their Medicaid programs to people with incomes up to 133 percent of the federal poverty level. (HHS, December 10, 2012)
• The Centers for Medicare and Medicaid Services (CMS) answered frequently asked questionsregarding exchanges, insurance market reform, and Medicaid expansion. (CMS, December 10, 2012)
• The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis (Kaiser Commission on Medicaid and the Uninsured, November 2012)
• Medicaid Expansion Briefing: What’s at Stake for States? (Alliance for Health Reform, November 2012)
• The Medicaid Upgrade: Required and Optional Medicaid Eligibility Changes for 2014 (Families USA, November 2012)
• Medicaid Coverage and Care for the Homeless Population: Key Lessons to Consider for the 2014 Medicaid Expansion (Kaiser Commission on Medicaid and the Uninsured, September 2012)
• A Closer Look: The Supreme Court's Health Care Decision (Families USA, August 2012)
• The Supreme Court Decision: What It Means for Medicaid (Families USA, August 2012)
  
  
• Medicaid Expansion: States’ Implementation of the Patient Protection and Affordable Care Act (Government Accountability Office, August 2012)
• Implementing the ACA’s Medicaid-Related Health Reform Provisions after the Supreme Court’s Decision (Kaiser Family Foundation, August 2012)
• Selected Issues Related to the Effect of NFIB v. Sebelius on the Medicaid Expansion Requirements in Section 2001 of the Affordable Care Act (Congressional Research Service, July 2012)
• How Will the Medicaid Expansion for Adults Impact Eligibility and Coverage? (Kaiser Commission on Medicaid and the Uninsured, July 2012)
• Letter from Department of Health and Human Services (HHS) Secretary Sebelius to Governors (July 10, 2012)
• Letter from Centers for Medicare and Medicaid Services (CMS) Acting Administrator Tavenner to Republican Governors Association (July 13, 2012)
• Opting Out of the Medicaid Expansion under the ACA: How Many Uninsured Adults Would Not Be Eligible for Medicaid? (Urban Institute, July 2012)
• Estimates for the Insurance Coverage Provisions of the Affordable Care Act Updated for the Recent Supreme Court Decision (Congressional Budget Office, July 2012) Note: This CBO analysis assumes that states will be able to partially expand Medicaid and receive the full expansion enhanced federal match. That is questionable. At roughly the same time that the CBO report was issued, the Congressional Research Service (CRS) issued a report on the impact of the Supreme Court decision. CRS concluded that the Secretary may not have the authority to issue partial expansions with the full enhanced federal match. This was further discussed in Sarah Rosenbaum's Health Affairs blog post.
• Medicaid Coverage and Spending in Health Reform: National and State by State Results for Adults at or Below 133% FPL (Kaiser Commission on Medicaid and the Uninsured, May 2010)
• Financing New Medicaid Coverage under Health Reform: The Role of the Federal Government and States (Kaiser Family Foundation, May 2010)
• Medicaid: An Overview of Spending on “Mandatory” vs. “Optional” Populations and Services (Kaiser Family Foundation, June 2005)

Tools to Make the Case for a State Expansion  

• A Fair Accounting of State Costs for the Medicaid Expansion (Families USA, January 2013)
• Assessing State Costs for the Medicaid Expansion: A Checklist (Families USA, January 2013)
• Infographic: How Many People Would Medicaid Expansion Cover? (Pew Charitable Trusts, January 2013)
• Faces of the Medicaid Expansion: Experiences of Uninsured Adults Who Could Gain Coverage (Kaiser Commission on Medicaid and the Uninsured, November 2012)
• The Role of Medicaid for Adults with Chronic Illnesses (Kaiser Commission on Medicaid and the Uninsured,November 2012)
• Implications of Medicaid Expansion Decisions on Private Coverage (American Academy of Actuaries, September 2012)
• Why a State's Health Insurers Should Support Expanding Medicaid (Center on Budget and Policy Priorities, September 2012)
• Medicaid Expansion: Framing and Planning a Financial Impact Analysis (State Health Reform Assistance Network, September 2012)
• Considerations in Assessing State-Specific Fiscal Effects of the ACA’s Medicaid Expansion(Urban Institute, September 2012)
• Investing in Medicaid Contributes to Better Education (Families USA, August 2012)
• Medicaid's Success: Good Care (Families USA, August 2012)
• Guidance on Analyzing and Estimating the Cost of Expanding Medicaid (Center on Budget and Policy Priorities, August 2012)
• A Historical Review of How States Have Responded to the Availability of Federal Funds for Health Coverage (Kaiser Commission on Medicaid and the Uninsured, August 2012)
• 10 Reasons the Medicaid Expansion Helps to Address Health Disparities (National Health Law Program, August 2012)
• 10 Reasons the Medicaid Expansion Is Good for Women (National Health Law Program, August 2012)
• 50 Reasons Medicaid Expansion Is Good for Your State (National Health Law Program, August 2012)
• Opting In to the Medicaid Expansion under the ACA: Who Are the Uninsured Adults Who Could Gain Health Insurance Coverage? (Robert Wood Johnson Foundation and the Urban Institute, August 2012)
• How Health Reform’s Medicaid Expansion Will Impact State Budgets: Federal Government Will Pick Up Nearly All Costs, Even as Expansion Provides Coverage to Millions of Low-Income Uninsured Americans (Center on Budget and Policy Priorities, July 2012)
• In July 2012, the State Budget Crisis Task Force, a group of budget experts organized by former Federal Reserve Chairman Paul Volcker and former New York Lt. Gov. Richard Ravitch, published a report looking at the finances of six large states. The "Ravitch-Volker" report noted that the Medicaid expansion is a good deal for states. Unfortunately, its chart comparing total state spending on Medicaid and education is misleading and overstates the comparative growth of Medicaid spending. If you look just at the share of state general fund spending, spending on education and Medicaid has been fairly constant. See this blog from the Center on Budget and Policy Priorities for a more detailed discussion.
• If you find someone quoting from the Ravitch-Volker report to argue that your state can't afford the Medicaid expansion, refer them to the blog link above. Also refer them to page 20 of the full Ravitch-Volker report, which says: "For states that want to increase coverage for the uninsured, ACA is a bargain."
• Uninsured Veterans and Family Members: Who Are They and Where Do They Live? (Robert Wood Johnson Foundation, May 2012)
• The Affordable Care Act’s Coverage Expansions Will Reduce Differences in Uninsurance Rates by Race and Ethnicity (Urban Institute, May 2012)
• Consider Savings as Well as Costs: State Governments Would Spend at Least $90 Billion Less With the ACA than Without It from 2014 to 2019 (Urban Institute, July 2011)

[Medicaid Home]