It’s been one year since the Supreme Court struck down the provision in the Affordable Care Act (Obamacare) requiring states to expand their Medicare programs. As a result of the ruling, expansion became a state by state decision, and the federal government could only offer incentives to entice states to participate. Expansion, according to the law, would open up coverage to seniors with an income of up to 138 percent of the poverty level. After a year, and with many states entering their new fiscal year on July 1, there are still a number that have not yet decided on expansion.
There is no deadline for states to decide, so the remaining states can decide to expand coverage at any time, or states that decided not to expand coverage can change their mind. The longer a state waits, however, the more federal dollars they lose out on. According to CQ, the Centers for Medicare and Medicaid Services will cover all of the costs for newly eligible adults for the first three years, but that rate phases down afterwards. In 2020, the federal matching rate will decline to 90 percent for all states, where it is supposed to remain.
This map from the Advisory Board Company shows where each state has come down on expansion. As of mid-June, there were 26 states participating in the coverage expansion, and one state (New York) leaning toward participating. Of the remaining states, 13 have actively said that they will not expand coverage, and six more are leaning that way. Four states are pursuing alternative models.
Advocates for expansion have not given up yet, and are hoping to see more states come on board or change their minds in the next few years. They point to states like Ohio, where the legislature seems likely to pass an expansion. State officials in Ohio have warned that implementation can take six months, but some advocates believe that implementation can happen by January 1, 2014.
The other states that seem likely to implement the expansion, or reverse their decision not to, include Florida, Indiana, New Hampshire, Michigan, Pennsylvania, and Tennessee.