States surveyed by the Government Accountability Office (GAO) say that Medicaid expansion will be challenging, citing budget uncertainties and the need for more federal guidance.
The Patient Protection and Affordable Care Act, passed two years ago, requires that states expand Medicaid eligibility levels and streamline enrollment processes by Jan. 1, 2014. (States also have the option to expand coverage to the newly eligible before the Jan. 1 date under the early expansion option.)
At the urging of Congress, GAO studied how Colorado, Georgia, Iowa, Minnesota, New York and Virginia are taking steps to prepare for Medicaid expansion. Most of the interviewed state budget directors said the reform provision will contribute to costs from 2012 to 2020, with administrative burdens of managing Medicaid enrollment, getting or updating IT systems to support the program and enrolling previously eligible but not enrolled individuals.
In addition to cost concerns, states reported not enough guidance from the Centers for Medicare & Medicaid Services. Although a few state budget directors said current CMS guidance like webinars was useful, most said they needed more information on developing budget estimates for benefits, eligibility determination and the FMAP (federal medical assistance percentage) match for newly eligible adults.
CMS said it will provide more guidance later this year. Reform must be in place by the beginning of 2014.
After the U.S. Supreme Court upheld health reform as constitutional, the U.S. Department of Health & Human Services reiterated that there's no deadline for states to decide to undertake the expansion. A state can receive an administrative federal match for IT costs, even if it hasn't decided to expand, as long as it's modernizing its eligibility systems. If a state decides to pass, it will not have to pay back the extra funding, GAO noted.
CMS estimates, as a result of the expansion, the number of Medicaid enrollees will grow by 14.9 million in 2014 and by 25.9 million in 2020.
In a Kaiser Family Foundation poll yesterday, most Americans support the idea of extending health coverage to low-income people, unless it costs their states more, Reuters reported. Sixty-seventy percent of respondents favored Medicaid expansion, but only 49 percent said they would like to see it in their own home states. A slight majority of 52 percent said they'd prefer the status quo if Medicaid expansion cost their states more.
For more information:
- check out the GAO summary and report (.pdf)
- see the Reuters article
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