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From Health Reform WK-EDGE, April 10, 2019

States continue to expand Medicaid, but will enrollment gains last?

By Patricia K. Ruiz, J.D.

A report by the Kaiser Family Foundation highlights continued Medicaid expansion but questions if expanded access will continue under Trump Administration.

Most states have expanded Medicaid to low-income adults under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), filling longstanding gaps in coverage, according to a report by the Kaiser Family Foundation (KFF). In the past year, five additional states have taken steps toward expanding Medicaid, bringing the total number of expansion states to 37, including the District of Columbia. However, the report questions whether changes under the Trump Administration will reverse coverage gains made under the ACA.

Closing coverage gaps. The ACA helped to fill gaps in Medicaid coverage by expanding eligibility to adults with incomes up to 138 percent of the federal poverty level (FPL) and provided federal funding to states for expansion coverage. Before the ACA, Medicaid eligibility was limited, and enrollment rules excluded many low-income adults and created barriers to enrollment for those were eligible. In the 14 states that have not adopted Medicaid expansion, eligibility remains tightly restricted, with the median eligibility level for parents at 40 percent of the FPL, and other adults remaining ineligible regardless of their income.

In adopting the policies of the ACA, all states have implemented more streamlined Medicaid enrollment and renewal processes, regardless of the states’ expansion status. Individuals were able to apply online for Medicaid in all states beginning January 2019, and most states can complete real-time determinations and automated renewals. These improvements facilitate individuals’ ability to enroll in and maintain coverage while reducing state administrative burdens.

Will advances continue? According to the report, a key question is whether there will be continued advances to expand coverage and streamline enrollment, as the Trump Administration is promoting new Medicaid eligibility requirements, including work requirements and restrictions to expansion, that would require complex and costly documentation. The report also notes that coverage gains under the ACA stalled and began to reverse in 2017, and Medicaid enrollment of adults and children declined in 2018. However, this could be the result of economic improvements.

Companies: Kaiser Family Foundation

IndustryNews: NewsStory AgencyNews EnrollmentNews MedicaidExpansionNews NewsFeed

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