State decision: Expansion of Medicaid coverage

When the Supreme Court ruled on the Affordable Care Act last year, it was widely hailed as a win for the healthcare reform law, according to the National Association of Healthcare Access Management (NAHAM), quoting an article in “Stateline.” While the court upheld the law’s core provision establishing health insurance exchanges, it found that the federal government could not force states to expand their existing Medicaid programs. The expansion was one of the several means established by the law to ensure that every American will be covered by health insurance.

As the Medicaid program stands now, children, pregnant women, the disabled, and the elderly can receive assistance through Medicaid if they are at, or below 133% of the federal poverty line. That qualification breaks down to about $31,000 for a family of four and $15,000 for an individual. The court struck down the provision that would have forced states to extend the program to any adult or family that is below 133% of the poverty line, regardless of their age or physical condition. That decision is left to each individual state.

According to statistics from the “Stateline” article, 21 states have accepted the expansion so far. That number could increase as well, as the Democratic governors of Arkansas, Missouri, and Montana have expressed a willingness to expand the program, despite challenges from their state legislatures. Since there is no deadline associated with this decision, some predict that it could be years before states decide if they will extend their Medicaid programs.

The federal government has pledged to pay all of the costs for the first three years of the program for any state that joins in expanded coverage, and up to 90% of costs after that. Many states, however, worry that the federal government will not be able to make good on its promise. There is also a concern that funding even 10% of the expanded program at the state level could be more than a state would be able to cover.

The decision to expand coverage is something that will likely be discussed in many state legislatures this year. Each state will have to weigh its own costs and benefits in the long run, and deal with conflicting ideas of the role of government in health care. (To see the entire article, go to