A Discussion with Leading Medicaid Directors: As FY 2013 Ends, Looking toward Health Care Reform Implementation in 2014

Issue Brief

1. In its June 2012 ruling in National Federal of Business v. Sebelius, the U.S. Supreme Court limited the federal government’s ability to enforce the ACA’s Medicaid expansion requirement effectively making implementation of the Medicaid expansion optional for states.

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2. John Holahan, Matthew Beuttgens, Caitlin Carroll and Stan Dorn, The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, November 2012), http://www.kff.org/medicaid/report/the-cost-and-coverage-implications-of-the/. NOTE: These estimates do not include savings states will realize from reductions in state spending for mental health and other state-funded programs, or new state revenues from increased economic activity. 

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3. “Status of State Action on the Medicaid Expansion Decision as of July 1, 2013,” Kaiser Family Foundation State Health Facts, accessed July 17, 2013, https://www.kff.org/medicaid/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/. 

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4. There is also concern that growth rates for the fourth quarter of 2012 and the first few quarters of 2013 are inflated due to one-time actions in response to federal tax changes related to the Fiscal Cliff as well as tax rate increases in California.

   Lucy Dadayan and Donald J. Boyd, Data Alert: Strong Growth in Personal Income Tax Collections in First Quarter of 2013 but Cloudy Fiscal Outlook (New York City, NY: The Rockefeller Institute of Government, June 5, 2013), http://www.rockinst.org/newsroom/data_alerts/2013/2013-06-SRR92_data_alert_djb_v2.htm.  

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5. The Michigan director noted that the governor, who supports expansion, proposed to deposit savings into a dedicated fund to be used to fund coverage in later years essentially making the expansion budget neutral for 21 years through the year 2034.

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6. Robin Rudowitz, Medicaid Financing: An Overview of the Federal Medicaid Matching Rate (FMAP) (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, September 2012), http://www.kff.org/health-reform/issue-brief/medicaid-financing-an-overview-of-the-federal/.

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7. Robin Rudowitz, Medicaid Financing: An Overview of the Federal Medicaid Matching Rate (FMAP) (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, September 2012), http://www.kff.org/health-reform/issue-brief/medicaid-financing-an-overview-of-the-federal/.

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8. Kaiser Commission on Medicaid and the Uninsured, Medicaid:  A Primer (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, March 2013), http://www.kff.org/medicaid/issue-brief/medicaid-a-primer/. 

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9. Benjamin D. Sommers, M.D., Ph.D., Katherine Baicker, Ph.D., and Arnold M. Epstein, M.D., “Mortality and Access to Care among Adults after State Medicaid Expansions,” New England Journal of Medicine, 367 (Sept. 13, 2012):1025-1034. 

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10. This study followed 10,405 persons selected in the lottery (the lottery winners) and 10,340 persons not selected (the control group). Katherine Baicker, Ph.D., and Amy Finkelstein, Ph.D., “The Effects of Medicaid Coverage – Learning from the Oregon Experiment," New England Journal of Medicine, 365 (August 25, 2011): 683-685. 

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11. Teresa A. Coughlin, Sharon K. Long, Lisa Clemans-Cope, and Dean Resnick, What Difference Does Medicaid Make (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, May 2013), http://www.kff.org/medicaid/issue-brief/what-difference-does-medicaid-make-assessing-cost-effectiveness-access-and-financial-protection-under-medicaid-for-low-income-adults/.

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