Implementing the ACA's Medicaid-Related Health Reform Provisions After the Supreme Court's Decision

November 28, 2012

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On June 28, 2012, the United States Supreme Court issued its decision about the constitutionality of the Affordable Care Act’s (ACA) Medicaid expansion. As written the ACA expands Medicaid eligibility, beginning in 2014, to nearly all people under age 65 who have incomes at or below 138% of the federal poverty level (FPL, $15,415 for an individual in 2012). The federal government will fund 100% of the expansion for most states’ costs in 2014 through 2016, gradually decreasing to 90% in 2020 and thereafter. The Supreme Court ruling on the ACA maintains the Medicaid expansion but limits the Secretary’s authority to enforce it. If a state does not implement the expansion, the Secretary cannot withhold existing federal program funds.