Partial Medicaid expansion: The next big healthcare policy issue?

With all eyes now trained on how the Trump administration might alter the Affordable Care Act (ACA) through regulation, it’s particularly worth watching how it handles one lesser-known option for states: partial Medicaid expansion.

Under “regular Medicaid expansion (Obamacare),” the program’s eligibility parameters include everyone with an income of up to 138% of the Federal Poverty Level (FPL).

But some states that declined that option and applied for a twist on expansion — which would have had Medicaid cover those with incomes up to 100% of the FPL, but not those between 100% and 138%. Those in the 100% to 138% range would instead be shifted to the ACA exchanges.

The Obama administration denied those requests, but its legal grounds to do so were rather flimsy, according to a perspective piece from The New England Journal of Medicine. In reality, the ACA leaves considerable room for states to tinker with Medicaid eligibility.

Enter Arkansas, which has applied for a federal waiver to allow it to enact a partial Medicaid expansion. If the Trump administration decides to grant that request, the article argues, it will “set a precedent with extraordinary practical, budgetary and political consequences.”

2017 Federal Poverty Levels can be accessed at the following link:
http://familiesusa.org/product/federal-poverty-guidelines

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