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Medicaid Expansion: Time For A Closer Look


December 11th, 2012

Medicaid plays a critical role in protecting the health of our nation’s most vulnerable populations, but it leaves out many people, including poor childless adults. To insure more people and fill these gaps in the program, the Affordable Care Act (ACA) allows states to expand their Medicaid programs to cover all adults earning up to 138 percent of the federal poverty level and pays 100 percent of expansion costs during the first three years, decreasing to 90 percent by 2020. This expansion of the Medicaid program accounts for about 50 percent of the coverage gains made possible by the law.

The Supreme Court’s ruling on the law left to the states the decision of whether to pursue this expansion, and some states on both sides quickly declared their intentions. Most, however, have chosen to delay a decision. Politics has been an important consideration for many, but with the election behind us, it’s time for the states to give greater attention both to the complex fiscal implications and the impact on those potentially eligible for the program.

With this in mind, the State Health Reform Assistance Network, an initiative funded by the Robert Wood Johnson Foundation, developed an analytical tool to help state policymakers assess the many variables involved in the decision and calculate the long-term fiscal impact on their state. While each state’s health care system, fiscal condition and demographics vary, the most important elements to consider do not. The State Network’s goal is to provide a reliable tool to help state leaders identify and evaluate all of the data that make up those elements.

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