Strategic implications: Medicaid expansion just became a far more complex and variable proposition

As part of Milliman’s blog series, “Ten strategic considerations of the Supreme Court upholding PPACA,” we consider the Supreme Court’s decision to allow states to opt out of Medicaid expansion and how it creates dynamic changes across the healthcare system.

Medicaid expansion just became a far more complex and variable proposition. The Supreme Court decision gives states the option not to participate in Medicaid expansion. In states that opt not to participate, there are big questions about how their Medicaid programs will function and how all this may affect the population that would have been Medicaid-eligible through the expanded coverage.

If a state does not participate in the Medicaid expansion, to what extent will those below the 133% federal poverty level (FPL) threshold qualify for premium tax credits and cost sharing subsidies?

Is a partial expansion possible? Are states that opt out of Medicaid expansion able to receive any portion of the enhanced federal funding available under PPACA through a partial expansion using waivers or a state plan amendment?

Are provisions of PPACA that are not explicitly tied to Medicaid expansion still in effect for states that opt out of the expansion? For example, will states have to abide by the primary care physician fee schedule increase that is scheduled for 2013 and 2014?

With the court upholding the exchanges and other components of the law, the interaction between Medicaid and these components creates a maze of issues for states, insurers, employers, and the uninsured.

For more comprehensive insight into Medicaid, click here.

Leave a Reply

Your email address will not be published. Required fields are marked *