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Health Care Reform:

Health Insurance & Affordable Care Act

States Still Struggling With Medicaid Expansion

Heated Debate continued...

In Indiana, the governor wants to boost spending on insurance for children instead of expanding Medicaid. Legislative debates over Medicaid continue in Virginia, Michigan, and Tennessee. Expansion died earlier this month in Pennsylvania.

In West Virginia, the governor is worried that red tape will prevent the state from offering expanded Medicaid in time for Jan. 1.

There’s no actual deadline for states to decide whether to expand eligibility, says Emma Sandoe, a spokeswoman for the U.S. Department of Health and Human Services. She said they could make a decision at any time and could expand Medicaid in 2014 if they wish.

States will be able to start Medicaid quickly after deciding to allow expansion, says Timothy Jost, a professor of law at Washington and Lee University. "The biggest delay will be if states try to get waivers to customize their programs, which many will likely do," he says.  

Options are limited for many poor people in states that don’t expand Medicaid, Sommers says. Those who are below the poverty level won’t be eligible for tax credits, he says, and “this means most people below the poverty level in non-expanding states will still be uninsured, even as their wealthier neighbors qualify for tax credits to buy coverage.”

In late June, the Department of Health and Human Services ruled that people who would have qualified under Medicaid expansion would be exempt from the requirement to have insurance if their state decides against Medicaid expansion.

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