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    Health Care Reform:

    Health Insurance & Affordable Care Act

    States Still Struggling With Medicaid Expansion

    Heated Debate continued...

    Earlier this month, the Kaiser Family Foundation reported that 23 states and the District of Columbia had agreed to expand Medicaid, and six were uncertain. Twenty-one weren't accepting expansion, at least at the moment. Because of differences in legislative calendars and procedures, though, the numbers are not that easy to pin down.

    New Hampshire and South Dakota have thrown the issue to committees. Utah is looking at a system proposed in Arkansas that would allow poor people to buy private insurance with Medicaid dollars. In Arizona, where expansion was pushed through recently, a move is afoot to repeal it.

    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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