Questions Linger About Implementing ACA’s Medicaid Expansion

With less than one year before the Affordable Care Act's Medicaid expansion takes effect, questions continue to linger about expansion costs, whether states will cooperate with the federal plan and a potential shortage of providers to meet the needs of a larger pool of insured U.S. residents, the Sacramento Bee reports.

About the Medicaid Expansion

An estimated eight million people are expected to obtain health insurance under the expansion in its first year, which observers say would be the largest one-year bump in enrollment in Medicaid's history (Pugh, Sacramento Bee, 2/13).

Under the ACA, the federal government will cover 100% of states' costs of the expansion until 2016, after which the federal share will decline gradually until it reaches 90% in 2020 (California Healthline, 12/11/12).

So far, 21 states and the District of Columbia have agreed to expand Medicaid, while 12 states have declined to participate in the expansion. The remaining 17 states have not announced their final decisions. According to the Bee, it is not clear how many states will end up accepting the expansion as there is no deadline for officials to make their decision.

Matt Salo -- executive director of the National Association of Medicaid Directors -- said every state that has implemented some type of expansion in their Medicaid programs in the past has seen higher-than-expected enrollment numbers, adding that "the people that show up are sicker" than the states expected.

Most of the eight million newly enrolled Medicaid beneficiaries in 2014 are expected to be low-income adults without children, according to the Bee. The rest of the new beneficiaries are expected to include low-income parents whose annual earnings exceed current eligibility requirements and low-income individuals with disabilities who do not qualify for the Supplemental Security Income program (Sacramento Bee, 2/13).

Medicaid Funding for Undocumented Immigrants

In related news, about $2 billion in Medicaid funding is spent annually on emergency care for patients who mostly are undocumented immigrants, Kaiser Health News reports. The funding -- which has not been widely publicized -- has been available since the late 1980s and makes up less than 1% of the program's total costs.

According to KHN, the funding "underscores the political and practical challenges" of declining to provide health benefits to undocumented immigrants. During the health reform debate in 2010, Democrats pledged to block the group from obtaining health benefits under the ACA. President Obama renewed that pledge when he released his immigration reform plan last month.

Federal law requires hospitals to treat all patients seeking emergency care, regardless of their citizenship or insurance status. While providers are prohibited from asking patients about their insurance or citizenship status, providers are able to determine their status if they are unable to provide a Social Security number or birth certificate.

Hospital officials and researchers who have studied the Emergency Medicaid funding program have reported that most of the funding is allocated for reimbursements to hospitals that deliver babies for women who enter their emergency departments.

A KHN analysis of data from seven states that are believed to have the highest undocumented immigrant populations found that the money goes toward emergency services for more than 100,000 individuals annually. California hospitals are recipients of nearly 50% of the funding.

Sonal Ambegaokar, a health policy attorney for the National Immigration Law Center, said there is no evidence that undocumented immigrants travel to the U.S. for emergency medical care, adding, "Immigrants migrate to the U.S. for job opportunities and reunifying with family members" (Galewitz, Kaiser Health News, 2/12).