In a letter dated July 10, the Republican Governors Association (RGA) sent a letter to President Obama posing 30 questions about the Medicaid expansion determined by the Supreme Court to be an optional provision of the recently-upheld Affordable Care Act (ACA).
The letter lays out several concerns of RGA, including the additional cost of funding the expansion to be borne by states and the sustainability of the Medicaid program in general. The letter goes on to ask questions specifically about how certain provision of the ACA should be implemented.
The Centers for Medicare and Medicaid Services' (CMS) acting administrator Marilyn Tavenner responded to the questions with a letter on July 13 that explains, among other things, that there is no date-certain by which states must choose whether to participate in the Medicaid expansion. Tavenner also clarifies that "a state can receive extra funding for Medicaid IT costs and Exchange implementation costs even if it has not yet decided whether to expand Medicaid eligibility or to run its own exchange." Tavenner then specifies that states will not have to pay that money back if they decide not to create their own exchange or expand Medicaid.