- Thirty-two states have accepted federal funding to expand Medicaid under the ACA, and at least four more are expected to do so in 2019.
- Fourteen states continue to refuse to adopt the Medicaid expansion.
- Nearly 10 million Americans have gained coverage through the ACA’s Medicaid expansion.
- Medicaid/CHIP enrollment in Medicaid expansion states has increased by 35.9 percent since 2013.
A provision in the Affordable Care Act (ACA) called for expansion of Medicaid eligibility in order to cover more low-income Americans. Under the expansion, Medicaid eligibility would be extended to individuals with incomes up to 138 percent of the federal poverty level.
But in June 2012, the Supreme Court ruled that states could not be forced to expand their Medicaid programs, so it was left to each state to determine whether to participate or not.
As of 2018, Medicaid had been expanded in 31 states and the District of Columbia. Maine, Virginia, Utah, Nebraska and Idaho are all poised to implement the expansion in 2019. (Virginia enrollment began in November 2018).
The federal government is financing most of the cost of expanding Medicaid, and a small portion is being paid by participating states. The costs for enrollees who are newly eligible under the expanded guidelines was covered 100 percent by the federal government until 2016. That will gradually decrease to 90 percent by 2020, but will not go below that amount.
As of 2017, nearly 10 million people had gained coverage as a result of Medicaid expansion (official Medicaid data put the total newly-eligible enrollment at more than 11 million as of the end of 2016, but this is a number that’s constantly in flux as enrollees’ circumstances change). Enrollment in Medicaid/CHIP in states that had expanded Medicaid increased by 13.6 million people – or 35.9 percent – between 2013 and July 2018.
However, in the states that have not expanded Medicaid, there’s a coverage gap that leaves about 2.2 million people ineligible for any sort of affordable coverage. To be clear, this is due to the decisions that their states have made, rather than a flaw in the ACA itself. The states could opt to accept federal funding to expand Medicaid at any time, thus closing the coverage gap.
The number of people in the coverage gap will shrink by about 84,000 people once Utah, Nebraska, and Idaho expand their Medicaid eligibility (Maine and Virginia are no longer included in the states with a Medicaid coverage gap, because Virginia’s expansion takes effect January 2019, and Maine voters approved Medicaid expansion in 2017, although the governor blocked implementation through 2018). Five states — Texas, North Carolina, Florida, Georgia, and Tennessee — account for the lion’s share of the coverage gap population, and they are among the 14 states where expansion is still a contentious issue and the legislature and/or governor are still strongly opposed to accepting federal funding to expand Medicaid.