State Medicaid Expansion Tracker

State Medicaid Expansion Tracker

The State Medicaid Expansion Tracker is a monthly publication from the National Association of States United for Aging and Disabilities (NASUAD). It focuses on actions and activities around the implementation of the Affordable Care Act's (ACA) optional Medicaid expansion.

Click here to download the full PDF of December's edition of the tracker.

After the enactment of the ACA in March 2010, lawsuits challenging various provisions of the law were filed in federal courts. Many of those cases were dismissed, but some federal appellate courts rendered decisions on the merits of the law. In November 2011, the United States Supreme Court agreed to consider several issues related to the constitutionality of the ACA arising out of two cases in the 11th Circuit Court of Appeals, National Federation of Independent Business v. Sebelius, and Florida v. Department of Health and Human Services. Oral arguments before the Supreme Court occurred over a three-day period in March 2012, and a ruling was issued on June 28, 2012, the last day of the Court's 2011-2012 term.

In agreeing to hear the case, the Supreme Court decided to focus on several specific questions raised in the lower courts, including the constitutionality of the ACA's Medicaid expansion. Through the ACA, Congress sought to extend Medicaid benefits to previously uncovered adults by creating a new mandatory eligibility group, beginning in 2014: non-elderly, non-disabled adults with incomes less than 133 percent of the Federal Poverty Level (FPL). To help states fund this expansion, the federal government agreed to pay 100 percent of the costs for this new population from 2014 through 2016, at which point the subsidy would gradually phase down until it reached 90 percent in 2020, where it would remain. Using its Spending Power, which allows Congress to attach conditions on the receipt of federal funds, lawmakers attempted to make all of a state's federal Medicaid funds, not just those associated with this newly-eligible population, contingent upon the state's compliance with the expansion. Arguing such an enforcement mechanism to be unduly coercive, 26 states successfully challenged this piece of the ACA.

In its June 2012 decision, the Court found all of the ACA to be constitutional, except the application of the Medicaid expansion as a mandate. To remedy this aspect of the law while leaving the rest intact, the Court essentially made state participation in the expansion optional by limiting the penalty for non-compliance to a loss of federal funding associated with the expansion only, rather than all of the state's Medicaid funding.

With coverage of this new adult population now optional, state officials have spent the intervening months weighing participation in the expansion, with varying results. To monitor state trends and progress around this issue, NASUAD has drawn from a variety of sources to compile the State Medicaid Expansion Tracker. We expect to update this analysis regularly, as 2014 approaches.

*Please note that new information presented in each issue is highlighted in yellow*