CMS Begins to Answer Questions Regarding Medicaid Expansion

At a recent National Conference of State Legislatures (NCSL) Annual Meeting, Cindy Mann, director of the Center for Medicaid and Children’s Health Insurance Program Services at CMS, announced that states will be provided a great deal of flexibility as they expand their Medicaid programs under the Affordable Care Act (ACA).

Two major concerns that arose following the Supreme Court decision on the Medicaid expansion were:
1)      If states could forgo the expansion initially, but opt to take up the expansion after the official January 2014 effective date;
2)      If states could choose to partially expand their Medicaid programs

Mann said that the federal government would permit states forgoing Medicaid expansion under the ACA to enroll in the program at a later date. While stopping short of ensuring that states would be allowed to expand their Medicaid program to certain populations, Mann did allude to the fact that states might be permitted to partially implement the expansion. In some states, lawmakers have asked whether they would be able to enroll eligible adults up to 100% federal poverty level (FPL), while those in the 101-133% FPL would pick up coverage in the state-based exchanges. She acknowledged the recent Congressional Budget Office and the Joint Committee on Taxation report which suggested that states might choose to partially implement the Medicaid expansion provision of the ACA. She said that her office was studying the report and would provide further guidance in the coming months. Former foster youth are among one of the newly eligible populations under the ACA’s Medicaid expansion,  so it will be key for child welfare advocates to continue to monitor implementation of this provision as Medicaid is one of the vital safety net programs for vulnerable children and youth.

According to CMS, the federal government’s read of the Supreme Court’s recent ruling with respect to Medicaid expansion is that the court intended for a truly voluntary expansion, and based on the insight that Mann shared with those in attendance at the recent NCSL meeting, CMS intends to comply with the intent of the ruling. She also made it clear that the federal government would not set a deadline for states to announce their intention to expand their Medicaid programs, (like they had for the state-based exchanges), instead giving states free will to choose when they take up the expansion, if they elect to do so at all. She cautioned however that states that choose to delay expansion risk missing out on federal funding for their eligible populations. Finally, Mann encouraged states to consider their options as it pertains to expansion and what it means for their respective states and their newly eligible populations.

In late July, NCSL released a legislative report showing 20 states had already enacted laws opposing some aspect of the ACA. Five of the twenty states went a step further by prohibiting their states from further implementation activities without approval by their legislatures.

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