Medicaid under the Affordable Care Act has seen many changes since the law first came into order in March 2010. The expansion of the Medicaid program was one of the most crucial parts of the extensive law, offering more Americans public health benefits than ever before. However, several months ago the Supreme Court somewhat eliminated that option by making Medicaid expansion a decision for each state to make.

Now the ability for more low-income individuals and families to get health insurance will remain the as it currently stands, be reduced, or increase to include a higher number of members, depending on your state’s decision. Many states immediately turned the expansion down, given the ability to opt-out, though it has not been finalized through Congress.

Fear that each state’s budget will suffer immensely brings politicians and some individuals skepticism regarding the expansion. On the other hand, is is estimated that 6 million Americans the expansion was projected to help may now be left without insurance. The Supreme Court also made it acceptable for members to be cut from the program, and making it more difficult to be eligible in most cases. Therefore, the expansion was essentially changed to restriction. It is now up to each state to decide whether to expand or contract Medicaid.

ACA Provisions for Medicaid Expansion

If a state chooses to go forward with Medicaid expansion, several changes will be made. Effective January 1, 2014, all states that will participate in Medicaid expansion are required to cover nearly all non-disabled adults under age 65 with family incomes less than or equal to 133 percent of the Federal Poverty Level (FPL). This drastically increases the current limit for most states, as many do not even offer Medicaid to low-income individuals without dependent children.

Other groups will also experience an increase in income guidelines, including children, pregnant women, and families – including parents and caretaker relatives. Washington State, for example, has already listed their income eligibility in 2014, as they plan to participate in opening up the program to more individuals. Below is an example of Washington Medicaid income criteria at the present time, and what it will be in January 2014.

Children

Pregnant Women

Adults

Federal funding is what sets the ACA’s Medicaid expansion apart from previous expansions. Between 2014 and 2016, the federal government intends to fund the entirety of the program’s expansion in each participating state. The federal support will taper off gradually, covering 90 percent of expansion costs in 2020 and going forward. States that do not choose to offer Medicaid to a larger number of individuals will not receive any federal funding.

Current State of Medicaid

While some states began taking action immediately on conjuring up statistics showing a massive debt in the state budget, others have accepted the expansion and are prepared to offer coverage to many more people. On both sides of the argument, heavy consequences are projected. States consider how many lives it could save and how much it will cost the state ultimately. According to a Harvard study, states where Medicaid has already been expanded have shown a longer life expectancy.

Large states, such as Florida and Texas, whose governors were the first to emphasize their favor for opting out, could strip millions of people of their access to coverage. The difference in mortality rates (shown by the Harvard study) in Florida would result in about 5,680 less deaths per year for adults under age 65. A consultant’s report also stated that Iowa Medicaid would cover up to 182,000 more residents if the expansion is chosen.

Aside from the expansion, Medicaid cuts are also taking place around the nation, with 13 states deciding to reduce benefits, pay health care providers less, or restricting eligibility. Most changes went into effect July 1, 2012, others will become effective later in the year, and some are pending approval. The states participating in the cuts include Alabama, California, Colorado, Connecticut, Florida, Hawaii, Illinois, Louisiana, Maine, Maryland, New Hampshire, South Dakota, and Wisconsin.

As the year progresses, we will have more information on the future of the Medicaid program in each state, and whether it will be more easy or difficult to receive state-funded health care coverage for individuals and families with a low-income.