A top CMS administrator says that officials expect every U.S. state to join the planned Medicaid expansion as part of the Affordable Care Act (ACA)—but many may wait until after the November elections.
Under the ACA, states were originally expected to expand Medicaid eligibility to residents making up to 133% of the federal poverty level, adding an estimated 17 million Americans to the program if implemented in all states. However, the Court's ruling on the ACA leaves each state's decision to participate in the hands of the nation's governors and state leaders.
State officials will "decide that it's in their state['s] interest to move ahead" with the expansion, CMS Deputy Administrator Cindy Mann said Monday at the Washington-based Bipartisan Policy Center.
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Although cost concerns are "central" to the states' decisions, Mann reiterted that the individuals who would most benefit from the expansion are "by and large not likely to be the cost drivers in the program." The costliest beneficiaries, such as patients with chronic conditions, tend to already be eligible for Medicaid, she said.
Citing cost concerns, governors from Florida, Louisiana, Mississippi, South Carolina, and Texas have already announced they will not implement the expansion, and at least five others have said they are leaning towards opting out as well.
According to the Congressional Budget Office's (CBO) latest estimates, about six million individuals who are eligible for the expansion will not gain coverage because of states opting out. The CBO estimates that about three million of the affected residents—those above the federal poverty line—could still receive coverage though the state-run exchanges (Daly, Modern Healthcare, 7/30 [subscription required]; Morgan, Reuters, 7/30; Levey, Los Angeles Times, 7/30).
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