Obama Administration to States on Medicaid Expansion: Take It or Leave It

On Monday, President Barack Obama’s Health and Human Services Department declared states that receive federal reimbursement for partaking in the Obamacare Medicaid expansion will have to cover all citizens 133% below the federal poverty line and cannot sign up for a partial expansion of Medicaid. 

After the Supreme Court ruled that states could not be forced to participate in the Medicaid expansion, the Obama administration and the states were left playing a “game of chicken”:

States have stayed mum on whether they will participate in the expansion, seeing first if they could get a better deal — the partial expansion. The federal government took awhile to show its cards: It wanted to see if states would sign up for the full expansion, without giving them a scaled back option. 

“Consistent with the law, there is not an option for enhanced match for a partial or phased in Medicaid expansion,” Marilyn Tavenner, the acting administrator for the Center for Medicare and Medicaid Services, said on Monday.

Medicaid administrator Cindy Mann said the administration’s position is that since they will be footing 100% of the bill for new enrollees, the states have to abide by the statue that contemplates, “with the enhanced match, that states will fully comply with the provisions of the law.”

“The law contemplated that every American would have a way to get health insurance coverage,” Mann said. “The Medicaid expansion to 133 percent was a method identified in the law to do that.”

In addition, White House officials have said Congress gave “states that really high finding in the service of a very specific goal: Ensuring all Americans have access to insurance options.”

Some states did not want to commit to the Medicaid expansion until they received an answer on whether they would be allowed to only cover people at or below the federal poverty line or those who were below 133% the federal poverty line and still get reimbursement from the federal government. 

Now that the Obama administration has definitely answered that they cannot, 24 undecided states will have to make a final decision about whether to join the program. 

To date, 17 states — including California, Montana, and Arkansas — have opted into the Medicaid expansion. Nine states (Texas, Florida, South Carolina, Georgia, Alabama, Mississippi, Louisiana, Oklahoma, South Dakota) will not partake in the expansion. Twenty-four other states — including New York, Pennsylvania, Ohio, Colorado, and Arizona — are undecided about whether to partake in the Medicaid expansion.