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  • Meagan Dorsch
    Public Affairs Director
    Denver
    303-856-1412
  • Jon Kuhl
    Public Affairs Specialist
    Washington, D.C.
    202-624-3557
May 19, 2011

NCSL seeks greater flexibility on Medicaid maintenance of effort requirements

WASHINGTON, D.C. - The National Conference of State Legislatures (NCSL) sent a letter to Senator Orrin Hatch and Congressman Phil Gingrey expressing its gratitude for introducing the State Flexibility Act. The State Flexibility Act restores Medicaid to its pre-American Recovery and Reinvestment Act (ARRA) status, giving states greater flexibility when making changes to the Medicaid program.

As part of the ARRA, and the Patient Protection and Affordable Care Act (PPACA), new Medicaid eligibility restrictions were imposed on the states, called “maintenance of effort” (MOE) requirements. These requirements prevent states from adjusting their eligibility levels and making other program changes. During these tough economic times, states cannot afford to have their hands tied by the federal government. States must be given the flexibility needed to provide health care services to their most vulnerable citizens and meet their budget obligations as required by state law or state constitution.

Keeping state budget constraints in mind, NCSL seeks greater flexibility for states, or alternatively, a permanent provision added to the Medicaid statute that would establish a countercyclical assistance program. This countercyclical assistance program would provide states with additional support to meet the increased participation in the Medicaid program during economic downturns, natural disasters and public health emergencies and to meet the financial burdens of any accompanying maintenance of effort requirements.


NCSL is a bipartisan organization that serves the legislators and staffs of the states, commonwealths and territories. It provides research, technical assistance and opportunities for policymakers to exchange ideas on the most pressing state issues and is an effective and respected advocate for the interests of the states in the American federal system.