Affordable Care Act News

ACA Brief: Medicaid Expansion

How Medicaid breaks down by state under the new health law

Here’s what you should know about Medicaid, the government-subsidized insurance program for the poor, and the expansion plan under the Affordable Care Act:
Federal law will cover 100 percent of costs in states that accept subsidy.
Currently, adults who don’t have children “don’t qualify for Medicaid no matter how poor they may be,” says Alan Weil, executive director of the National Academy for State Health Policy. But the Affordable Care Act (ACA) expands Medicaid for adults to 133 percent of the federal poverty level without regard for family structure.
There will still be some people without health insurance after ACA is implemented. If all states accept Medicaid expansion, it is projected the number of uninsured will drop to 28 million, down from 53 million without ACA.
A state can decide to accept Medicaid expansion at any time, but the benefits will only be effective from the date the state decides to participate in the program. It’s not retroactive.
Understand that spending forecasts will be wrong. Massachusetts, which started its own expansion program in 2006, spent $1 billion in year one and $2 billion by year three. That’s because for many years people had just been covering their basic health-care demands, experts say. Aggressive outreach boosted enrollment in the plan faster than expected. But there’s good news: The cost overages aren’t breaking the bank.
“Medicaid is large and expensive. But being uninsured is a pretty lousy thing,” Weil says. “We have very clear evidence from well-designed studies that show having Medicaid coverage reduces illness and reduces death.”

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