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Implementing the ACA’s Medicaid-Related Health Reform Provisions After the Supreme Court’s Decision

On June 28, 2012, the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act (ACA). A majority of the Court also found the ACA’s Medicaid expansion unconstitutionally coercive of states, while a different majority of the Court held that this issue was fully remedied by limiting the Health and Human Services (HHS) Secretary’s enforcement authority. The practical effect of the Court’s decision makes the Medicaid expansion optional for states.

This brief addresses questions that may arise for states in the wake of the Supreme Court decision, including what parts of the ACA are affected by the decision, whether states can opt in and out of the Medicaid expansion over time, whether federal payments to hospitals for uncompensated care will still be reduced if a state does not expand its Medicaid program, and whether the Court decision affects the ACA’s maintenance of effort provisions.

Report (.pdf)