AMA Wire

Wednesday, July 25, 2012

This Week's News

U.S. Supreme Court's ACA decision raises questions about Medicaid

U.S. Supreme Courts ACA decision raises questions about Medicaid

Health insurance coverage for some of America's poorest patients is uncertain following the Supreme Court of the United States' recent ruling on the Affordable Care Act (ACA), which upheld the majority of the law but rendered the Medicaid expansion provision optional.

Ruling that Congress had exceeded its power in threatening to withhold existing Medicaid funding to states that did not expand their programs, the court left it up to the individual states to choose whether to accept the additional federal funding for expansion or maintain their existing programs.

Coverage possibilities for poor patients in states that opt out are not yet certain. For instance, patients at 100 to 133 percent of the federal poverty level could be eligible for federal subsidies to purchase insurance through an exchange. But patients who are below the federal poverty level and are not already eligible for Medicaid would not qualify for subsidies and would likely remain uninsured.

According to a recent article in American Medical News, 13 states have announced their intent to participate in the expansion, while another 30 states remain uncommitted. Seven states already have said they will opt out of the Medicaid expansion.

Some of the states opting out also are seeking to tighten eligibility requirements for their existing Medicaid programs. They argue that the court's decision confirms they now have more flexibility to manage their state's program, American Medical News reports.

Kathleen Sebelius, secretary of the Department of Health and Human Services, and Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services, both have said that the court's decision leaves intact all other aspects of the ACA that affect Medicaid.