Summary Report: Implementing The ACA’s Medicaid-Related Health Reform Provisions

A new policy report from Kaiser Health News answers some common placed questions following the Supreme Court’s June 28 decision.  In the report, questions are clearly answered with great detail and with the appropriate context – those answers can be viewed here.

The following 10 questions are taken directly from the Kaiser report, however, the responses to each question are the very basic summaries of the complete answers that were provided in the full report:

1.  What parts of the ACA are affected by the Court’s Decision?

The Court’s decision focuses only on the ACA’s Medicaid Expansion.

2.  What guidance has the Administration issued after the Court’s decision?

HHS Secretary Kathleen Sebelius sent a letter to state governors that points out the Court’s decision affects only the “expansion of Medicaid eligibility for low-income adults,” and that it “did not affect other provisions of the law.”

3.  Does the Court’s decision affect the ACA’s Medicaid expansion to 138% FPL for children ages 6 to 18?


4.  Does the Court’s decision affect the ACA’s maintenance of effort provisions?


5.  Does the Court’s decision affect the ACA’s eligibility and enrollment simplification procedures?


6.  Does the Court’s decision affect other ACA changes to Medicaid?

No, but the ACA makes a number of other changes to the Medicaid program that are not impacted by the court’s decision and remain in effect.

7.  Can states expand eligibility to an income limit less than 138% FPL and still receive the enhanced FMAP?

No, states must cover the entire group of people up to 138% FPL based on the plain language of the ACA.

8.  Can states opt in and opt out of the ACA’s Medicaid expansion over time?

Yes, states can implement the ACA’s Medicaid expansion for a period of time and then stop doing so, presumably without risking the loss of existing non-ACA expansion Medicaid funds.

9.  Will the Secretary apply her § 1115 waiver authority to the ACA Medicaid expansion group?


10.  If a state does not take up the Medicaid expansion, will its DSH funds still be reduced?