More than 80% of states wait on Medicaid expansion

However, many are taking on other ACA challenges

Just seven states and the District of Columbia are expanding Medicaid coverage ahead of new requirements in the Affordable Care Act.

Beginning in 2014, the ACA will make almost every U.S. citizen with an income up to 133% of the federal poverty level eligible for coverage in an effort to lower the number of uninsured Americans.

However, the legislation offers states an opportunity to receive additional federal Medicaid funding before the law is fully enacted—and only California, Colorado, Connecticut, D.C., Minnesota, Missouri, New Jersey, and Washington have opted for early expansions.

“It was fiscally advantageous for those states," to move quickly, according to Robin Rudowitz, an associate director with the Kaiser Commission on Medicaid and the Uninsured in a policy brief. The states already provide optional coverage to low-income adults through either national or state funding.

Glen Stream, president of the American Academy of Family Physicians notes that the increase in Medicaid beneficiaries will result in more physician office visits. However, low Medicaid reimbursements do not always cover the high costs of treating a patient. Stream highlights this as a case for making the ACA’s Medicaid parity provision—which reimburses primary care physicians at slightly higher Medicare rates for two years—a permanent one.

The economic downturn has prevented other states from getting an early start on this provision. However, most of the remaining 43 states have made progress on at least one of the four other options to improve their Medicaid program that the ACA maps out. Thus far:

  • Twenty-eight states and D.C. have made upgrades to Medicaid eligibility;
  • Twenty-six states have applied for integrated care models for dual eligible beneficiaries; and
  • Ten states have received a five-year grant funding preventative medicine for chronic diseases.

However, Rudowitz cautions that the Kaiser policy brief does not offer a complete picture of how states are revising their Medicaid programs (Lubell, American Medical News, 6/11).

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