Medicaid—a federal/state partnership with shared authority and financing—is a public health coverage program for low-income children, their parents, the elderly and people with disabilities. Medicaid pays for health and long-term care services for more than 55 million people. Although participation is optional, all 50 states participate. Eligibility varies widely among states because, although states must meet federal minimum requirements such as covering certain people and offering specific benefits, they may also choose to cover additional “optional” people and services.
Provisions of the Patient Protection and Affordable Care Act (PPACA) expanded Medicaid to all Americans under age 65 whose family income is at or below 133 percent of federal poverty guidelines ($14,484 for an individual and $29,726 for a family of four in 2011) by Jan. 1, 2014. As passed by Congress, states failing to participate in this expansion would risk losing their entire federal Medicaid allotment.
The Medicaid expansion provision of the law led to challenges that rose to the Supreme Court where, on June 28, 2012, the court ruled that Congress may not make a state’s entire existing Medicaid funds contingent upon the state’s compliance with the PPACA Medicaid expansion. In practice, this ruling makes the Medicaid expansion a voluntary action by states.
The Court's decision sparked many questions from state policymakers. In a series of letters, the Department of Health and Human Services (HHS) has begun to clarify its interpretation of the ruling. In the initial letter on July 10, HHS Secretary Kathleen Sebelius addressed the decision and the next steps. Furthermore, responding to a letter from the Republican Governors Association (RGA) requesting additional guidance from the Obama administration, Marilyn Tavenner, the acting administrator of the Centers for Medicare and Medicaid Services, clarified in a letter that no deadlines had been set for states to make a decision concerning the expansion of their Medicaid programs.
Given this new choice, states are weighing the costs and savings associated with expanding Medicaid to cover most people under the age of 65 with incomes at or below 133 percent of the federal poverty guidelines. Even with the federal government paying for a significant portion of the cost of coverage for the newly eligible—100 percent in 2014 through 2016, decreasing to 90 percent in 2020 and thereafter—fiscal uncertainties remain.
Below is a map showing which states are currently moving forward with ACA-related expansion, not moving forward at this time, using an alternative method to expand or undecided.