Medicaid Expansion, Health Coverage, and Spending: An Update for the 21 States That Have Not Expanded Eligibility

Issue Brief

1. Beginning in 2014, the higher FMAP for newly-eligible Medicaid beneficiaries is available for non-elderly, non-disabled adults with incomes up to 138% FPL who would not be eligible for Medicaid under the rules that a state had in place on December 1, 2009.

   A few states had already expanded coverage to parents and childless adults up to 100% FPL or to higher income levels across the state at the time the ACA was passed. Costs related to these populations qualify for the “expansion” or “transition” FMAP instead. In recognition of these states already provided coverage at these higher Medicaid eligibility levels, these states can receive a phased-in increase in their federal matching rate for adults without dependent children under age 65 beginning on January 1, 2014 so that by 2019 it will equal the enhanced matching rate available for newly-eligible adults. In addition, expansion states that do not have any newly-eligible Medicaid beneficiaries because they already covered people up to 138% FPL or higher (e.g. Massachusetts) also receive a temporary (January 1, 2014 through December 31, 2015) 2.2 percentage point increase in their federal matching rate for all populations.

   For more information on how claiming works for the Medicaid expansion, please see the following brief:

   Robin Rudowitz, Understanding How States Access the ACA Enhanced Medicaid Match Rates. (Washington, DC: Kaiser Family Foundation,) September 2014. https://www.kff.org/medicaid/issue-brief/understanding-how-states-access-the-aca-enhanced-medicaid-match-rates/.

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2. More information about methodology can be found at “Further Methodological Information for ‘Tax Preparers Could Help Most Uninsured Get Covered,’” accessed May 7, 2014, http://www.urban.org/health_policy/health_care_reform/taxfilingmethodology.cfm  and Urban Institute. “The Urban Institute’s Health Microsimulation Capabilities,” Washington, DC: Urban Institute, 2010, http://www.urban.org/publications/412154.html.

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3. John Holahan, Matthew Buettgens, and Stan Dorn, The Cost of Not Expanding Medicaid, (Washington, DC; The Kaiser Commission on Medicaid and the Uninsured; July 2013) https://www.kff.org/medicaid/report/the-cost-of-not-expanding-medicaid/;  John Holahan, Matthew Buettgens, Caitlin Carroll, Stan Dorn, The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis, Kaiser Commission on Medicaid and the Uninsured, November 2012, https://www.kff.org/health-reform/report/the-cost-and-coverage-implications-of-the/

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4. Matthew Buettgens (2011) HIPSM Methodology. The Urban Institute, Washington, DC. http://www.urban.org/research/publication/health-insurance-policy-simulation-model-hipsm-methodology-documentation

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5. Teresa A. Coughlin, John Holahan, Kyle Caswell, and Megan McGrath (2014) Uncompensated Care for the Uninsured in 2013: A Detailed Examination. The Urban Institute. Washington, DC.  https://www.kff.org/uninsured/report/uncompensated-care-for-the-uninsured-in-2013-a-detailed-examination/

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6. Samantha Artiga, Robin Rudowitz, Alexandra Gates and Laura Snyder, Recent Trends in Medicaid and CHIP Enrollment as of January 2015: Early Findings from the CMS Performance Indicator Project (Washington, DC; The Kaiser Commission on Medicaid and the Uninsured; March 2015).  https://www.kff.org/medicaid/issue-brief/recent-trends-in-medicaid-and-chip-enrollment-as-of-january-2015-early-findings-from-the-cms-performance-indicator-project/

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7. Sharon K. Long, Michael Karpman, Genevieve M. Kenney, Douglas Wissoker, Nathaniel Anderson and Stephen Zuckerman (2015) “QuickTake: Taking Stock: Health Insurance Coverage under the ACA as of December 2014.” The Urban Institute, Washington, DC;

   HHS/ASPE (2015) Health Insurance Coverage and the Affordable Care Act. http://aspe.hhs.gov/health/reports/2015/uninsured_change/ib_uninsured_change.pdf.

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8. Stan Dorn, Norton Francis, Robin Rudowitz, and Laura Snyder (2015) “The Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States.” Kaiser Commission on Medicaid and the Uninsured. http://files.kff.org/attachment/issue-brief-the-effects-of-the-medicaid-expansion-on-state-budgets-an-early-look-in-select-states

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9. Dorn, et al. “The Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States.”  https://www.kff.org/medicaid/issue-brief/the-effects-of-the-medicaid-expansion-on-state-budgets-an-early-look-in-select-states/

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10. Department of Health and Human Services, Office of the  Assistant Secretary for Planning and Evaluation, “Insurance Expansion, Hospital Uncompensated Care and the Affordable Care Act,” March 23, 2015,  http://aspe.hhs.gov/health/reports/2015/MedicaidExpansion/ib_UncompensatedCare.pdf; Teresa A. Coughlin, Sharon K. Long, Rebecca Peters, Robin Rudowitz and Rachel Garfield. Evolving Picture of Nine Safety-Net Hospitals:  Implications of the ACA and Other Strategies. (Washington, DC: Kaiser Commission on Medicaid and the Uninsured), April 2015, https://www.kff.org/health-reform/issue-brief/evolving-picture-of-nine-safety-net-hospitals-implications-of-the-aca-and-other-strategies/.   Peter Cunningham, Rachel Garfield, Robin Rudowitz. How Are Hospitals Faring Under the Affordable Care Act? Early Experiences from Ascension Health.  (Washington, DC: Kaiser Commission on Medicaid and the Uninsured), April 2015, https://www.kff.org/health-reform/issue-brief/how-are-hospitals-faring-under-the-affordable-care-act-early-experiences-from-ascension-health; Colorado Hospital Association. “Impact of Medicaid Expansion on Hospital Volumes.” ACA Center for Health Information and Data Analytics.  June 2014. http://www.cha.com/Documents/Press-Releases/CHA-Medicaid-Expansion-Study-June-2014.aspx.

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