The Effects of the Medicaid Expansion on State Budgets: An Early Look in Select States

Appendix B: Optional Medicaid Eligibility Pathways

Prior to the ACA, some states had adopted Medicaid eligibility pathways that provided limited coverage (meaning that the coverage provided limited benefits or the coverage offered full Medicaid benefits but limited eligibility to those that either had a specific condition or those that met spend-down requirements.) The availability of subsidized Marketplace coverage and expanded Medicaid coverage (in 28 states) provides new options for states to reconsider some of these coverage options, such as:

• Family Planning. Family planning waivers and state plan amendments allow for states to provide limited Medicaid coverage to US citizens otherwise ineligible for Medicaid (largely adults.) Coverage is limited to family planning services only and is reimbursed at 90 percent federal match. Washington State had an existing family planning waivers; Connecticut and New Mexico had previously adopted the family planning state plan option. None of the case study states had elected to eliminate this coverage, though across the country, eight states reported plans to end family-planning only coverage.¹
• Breast and Cervical Cancer Treatment (BCCT). In 2000, Congress gave states the option to extend Medicaid coverage to low-income uninsured or underinsured women under age 65 that had been screened and diagnosed with breast and cervical cancer through state screening programs funded by the CDC. All states had adopted this option; coverage for these individuals is reimbursed at the state’s CHIP matching rate. None of the case study states had elected to eliminate this coverage, though across the country, three states reported plans to end BCCT coverage.²
• Medically Needy Spend-Down. Another optional Medicaid eligibility pathway that some states considered eliminating in light of new coverage options was medically-needy spend-down programs for adults. Under this coverage group, people can qualify for Medicaid by incurring medical bills that “spend down” their income to lower levels. None of the case study states had elected to eliminate this coverage, though across the country, five states reported plans to reduce or end medically needy spend-down coverage for adults.³