The Government Accountability Office (GAO) has issued a report to the Senate Committee on the Judiciary discussing actions states are taking to implement the Medicaid expansion contained in the Patient Protection and Affordable Care Act (ACA). Specifically, the report addresses three questions that the Committee asked the GAO to answer:
- What are states' responsibilities for implementing the Medicaid expansion provisions under the ACA?
- What actions have selected states taken to prepare for the Medicaid expansion provisions of ACA and what challenges have they encountered?
- What are states’ views on the fiscal implications of the Medicaid expansion on state budget planning?
The report says that states that choose to implement the Medicaid expansion must cover eligible lower-income individuals before higher-income individuals; must provide a streamlined eligibility process, including web applications for potential enrollees; and must interface state eligibility determination systems with a Federal Data Services Hub. The report further details the actions that six states have undertaken in preparation of the Medicaid expansion.
The report concludes that state budget directors believe that some aspects of Medicaid expansion will contribute to costs in their states, that some aspects are difficult to gauge final budgetary impact, and that their states' share of Medicaid expenditures create challenges for implementing the expansion. The majority of state budget directors reported that additional guidance from the Centers for Medicare & Medicaid Services would be helpful in the areas of Medicaid benefits packages, Medicaid eligibility determination and the Federal Medical Assistance Percentage match for newly eligible adults.