By Amy Killelea, Senior Manager, Health Care Access, NASTAD
The Medicaid expansion is a significant opportunity to expand access to care to people living with HIV and viral hepatitis, making the debates over expansion playing out in state governors’ offices and legislatures incredibly important. Because of the Supreme Court decision limiting the federal government’s power to force states to comply with the Affordable Care Act’s (ACA) Medicaid expansion, there is a real question of if and when every state will comply with the expansion. However, over the past several weeks, several governors who have had been vocal opponents of the ACA since its passage have announced that they will be expanding Medicaid in 2014. Governor Kasich of Ohio became the most recent in a growing list of conservative governors to announce support of the Medicaid expansion. Ohio joins Arizona, New Mexico, and Nevada, where Republican governors also recently announced their support of the expansion. All four governors cited fiscal reasons – the federal government pays for the overwhelming majority of the expansion – as the primary reason for their support of expansion.
The map below produced by the Center on Budget and Policy Priorities sums up the growing trend towards support of the Medicaid expansion.
Medicaid Expansion Advocacy is Paramount and Will Continue Beyond 2014
If states do not expand in 2014, they can still opt into the expansion at any time (but the full 100% federal funding for the expansion only applies for 2014 through 2016). We are likely to see continued movement on this issue as state legislatures convene and as advocacy efforts in support of the expansion ramp up over the coming weeks and months. These state advocacy efforts have been successful in large part because they have been made up of broad coalitions, many of whom are not traditionally allies. For example, in addition to low-income health advocates, hospital associations have become vocal supporters of the expansion. This is largely because of a provision in the ACA that reduces federal funding for safety net hospitals. This reduction occurs regardless of whether a state expands Medicaid, and in states that do not expand, safety net hospitals will still be seeing a large number of uninsured people, but with less federal money.
ACA Medicaid Reforms Happening in States Regardless of Decision to Expand
Even in states that have opposed or remain undecided about the Medicaid expansion, there are still Medicaid reforms happening. The ACA introduced a number of Medicaid changes and upgrades that states must implement regardless of whether they decide to expand Medicaid, including:
- Simplified and streamlined eligibility and application process
- New income formula (called Modified Adjusted Gross Income) that will be used for any existing Medicaid beneficiaries, not just the expansion population
To prepare for these reforms and to take advantage of additional federal money to implement them, the vast majority of states are engaged in massive upgrades to their Medicaid systems. Even in states that do not expand in 2014, there may be opportunities for HIV/AIDS and viral hepatitis programs to coordinate with and leverage these new systems going forward. The map below produced by Kaiser Family Foundation illustrates the status of Medicaid eligibility changes.
The recent movement toward support of the Medicaid expansion in conservative states is a testament to the concerted advocacy efforts of broad coalitions of providers, consumers, and business owners. These coalitions continue to make the case for why the Medicaid expansion makes sense from an individual health, public health, and economic perspective.