New Resources Available on Medicaid Expansion in Wake of Supreme Court Decision

by Rebecca Farley on July 26, 2012

As states consider whether to carry out the Affordable Care Act’s Medicaid expansion, new resources are available for advocates seeking to learn about the expansion’s effect on their state and engage with state policymakers to influence the decisionmaking process.

The Supreme Court effectively made the Medicaid expansion optional when it ruled last month that the federal government cannot withhold existing Medicaid funds from states that do not comply. This leaves each state with the authority to decide whether or not it will participate in the expansion. Guidance from HHS earlier this year also gave states substantial discretion in determining their own essential benefits packages (the minimum coverage standards that Medicaid expansion plans must meet). This means that many of the most critical decisions about whether and how to cover new populations in Medicaid will take place at the state level, providing opportunities for providers and advocates to give input on how to ensure adequate benefits for people with mental illness and addictions.

Who will remain uninsured if your state opts out of the expansion? Because the Affordable Care Act relied on Medicaid as the sole means of extending coverage to uninsured Americans below 100% of poverty, there is the potential for a “donut hole” in coverage. People currently enrolled in Medicaid would stay on Medicaid and those above 100% of poverty could receive subsidies to purchase insurance in the state-based insurance exchanges – but those in between would remain uninsured. The Washington Post has produced an excellent set of charts illustrating on a state by state basis who will remain uninsured should a state choose not to participate in the expansion.

Bazelon Center Outlines Decision Points and Recommendations for Carrying Out the Medicaid Expansion. A new report by the Bazelon Center for Mental Health Law highlights the key decision points where advocates can engage with states to ensure the best possible coverage for people with mental illness and addictions. The report walks through, step by step, questions such as:

  • Will your state expand Medicaid?
  • If so, what benefit package will newly eligible individuals receive?
  • How will your state define essential health benefits for these individuals?

The report offers descriptions of each issue, policy recommendations, and talking points for advocates. Don’t have time to read the whole report? Take a look at the National Council’s flowchart summarizing the major decisions and considerations ahead.

Study Finds Evidence of Reduced Mortality in Expansion States. A study published today in the New England Journal of Medicine details the results from a three-state study examining the impact of Medicaid eligibility expansions on mortality. The researchers looked at all-cause, all-population mortality in Maine, Arizona, and New York for a period 5 years before and 5 years after those states’ Medicaid expansions. They compared this data with mortality in control states and found that the Medicaid expansions were associated with a relative mortality decline of 6.1%, or 2,480 fewer deaths per year for every 500,000 people added to the Medicaid rolls. Expansion states also experienced a 21% reduction in delayed care because of cost and a 3% increase in self-reported “excellent” or “very good” health. The researchers cautioned that limitations in the data make it difficult to know whether Medicaid expansions in other states will achieve the same results. However, this study adds to earlier research from Oregon’s Medicaid expansion showing evidence of the health benefits of Medicaid coverage.



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