TO EXPAND OR TO NOT EXPAND: THAT IS THE QUESTION

With the Supreme Court’s June 2012 decision on the Affordable Care Act (ACA) making the Medicaid expansion optional, governors and state officials must make crucial decisions whether to participate in Medicaid’s expansion, affecting millions of Americans. There is no deadline for states to indicate they want to expand, but the next several months will be telling—with states running cost estimates to inform their decision. The earlier a state opts in to the Medicaid expansion, the more federal support they receive.

What does all this mean? Nuts and Bolts of Medicaid and the Medicaid Expansion:

• Medicaid provides health coverage to nearly 9 million non-elderly individuals with disabilities, including people with multiple sclerosis (MS)
• Medicaid is jointly financed by the state and federal governments
• Currently, Medicaid is managed by each state and certain provisions, such as eligibility rules and services provided range widely from state to state

•  The ACA included standardized and more generous (i.e., “expanded”) standards for Medicaid eligibility for lower income persons
• However, the U.S. Supreme Court found the ACA’s Medicaid expansion to be unconstitutional as written. Seven Justices felt that forcing states to accept the ACA’s expansion in order to not lose the federal government’s share of Medicaid financing was coercive and a violation of the 'spending clause'

If all states expand their Medicaid programs, up to 21.3 million Americans, including people with MS could gain access to affordable, quality and comprehensive coverage.  Medicaid provides people with MS prescription drug coverage and standard medical benefits like physician and hospital care as well as home- and community-based services that allow people with MS to remain independent and other forms of long-term services and support.

So far, 18 states and the District of Columbia have announced that they will be participating in the ACA's opportunity to expand Medicaid.  As part of the National MS Society's Unified State Policy Agenda and in line with the Society's National Health Care Reform Principles, the Society urges all states to fully expand Medicaid so that all qualified have access to affordable, comprehensive health care.  For a list of states participating, please click here.  If your state is undecided or leaning towards participating, please contact your chapter to see how you can help advocate for Medicaid expansion in your state.