Medicaid Expansion
In an effort to extend health care coverage, the ACA will give states the option of expanding Medicaid eligibility. Details of the Medicaid expansion are as follows:
- The expansion will allow for Medicaid coverage of all legal resident childless adults with an income at or below 133% of the federal poverty level, with a 5% income disregard. It is estimated that, as a result of the Medicaid expansion, up to 16 million additional individuals could become eligible for Medicaid, representing a 30% potential increase in the number of Medicaid enrollees.
- For states that choose to participate, the expansion will begin on January 1, 2014, unless states choose to expand their Medicaid eligibility early. In the meantime, states will be required to maintain their current levels of coverage under so-called “maintenance of effort” (MOE) provisions.
- For the newly eligible population, the ACA increases the rate of Federal Medical Assistance Percentages (FMAP) to states as follows:
2014 through 2016 |
100% federally funded (FMAP) |
2017 |
95% federally funded |
2018 |
94% federally funded |
2019 |
93% federally funded |
2020 onwards |
90% federally funded |
- To receive full federal matching funds, states must expand Medicaid to 133% of the federal poverty level. States that wish to engage in only a partial expansion will not be eligible for enhanced FMAP rates.
- For states that expanded their Medicaid programs prior to December 1, 2009, the federal government will provide an alternate increased FMAP to match expenditures for adults who would otherwise be considered newly eligible.
Participating |
Undecided |
Not Participating |
Arizona |
Alabama |
Indiana |
Arkansas |
Alaska |
Pennsylvania |
California |
Georgia |
Utah |
Colorado |
Idaho |
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Connecticut |
Kansas |
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Delaware |
Louisiana |
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District of Columbia |
Mississippi |
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Florida |
Missouri |
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Hawaii |
Nebraska |
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Illinois |
North Carolina |
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Iowa | Oklahoma |
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Kentucky |
South Carolina |
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Maryland |
South Dakota |
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Massachusetts |
Tennessee |
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Michigan |
Texas |
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Minnesota |
Virginia |
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Montana |
Wisconsin |
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Nevada |
Wyoming |
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New Hampshire |
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New Jersey |
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New Mexico |
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New York
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North Dakota |
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Ohio |
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Oregon
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Rhode Island |
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Vermont |
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Washington |
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West Virginia
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The Medicaid expansion will involve collaboration among federal agencies, including CMS and HHS, and state Medicaid agencies. To date, implementation of the ACA’s provisions on Medicaid expansion include the following:
- Revised requirements for mechanized claims processing and information retrieval systems.
- Guidance from CMS to the states about the impact of the Supreme Court decision on the implementation of Medicaid expansion and compliance with MOE requirements.
- Federal funding to make major improvements to state Medicaid eligibility systems in preparation for the expansion.