The one aspect of the Affordable Care Act that the Supreme Court threw out was the requirement that states expand their Medicaid coverage. The federal government is free to expand the program but states are not required to participate with the expansion and the federal government can not cut off existing Medicaid dollars to those states that choose not to participate with the expansion.
The federal government picks up close to 57% of the cost of Medicaid at the state level and if that funding would have gone away most states would have been forced to significantly reduce services or eliminate Medicaid all together.
Missouri must now decide if they will expand Medicaid because the Supreme Court has given Missouri, and every other state, a choice.
The expansion of Medicaid is a key aspect of the ACA and it is the key provision that will help provide coverage to the uninsured. It’s estimated that the expanded Medicaid coverage would provide new coverage to 17 million people who are currently uninsured.
If states choose to participate in the expanded Medicaid program the first three years will be easy. The federal government will cover 100% of the cost of the expanded services for the first three years but after that, states will have to pick up 10% of the cost of the expansion.
Expanding Medicaid in Missouri would cover an additional 410,000 people. Medicaid spending by enrollee in Missouri currently averages $4,850 per year.
Missouri will get an additional $9.5 billion over the next six years from the federal government if it chooses to participate in the expansion but the state must come up with $385 million on its own to cover it’s portion.
Now you see the dilemma. Missouri has a difficult time reaching a balanced budget now, where will another $385 million come from?
You’re going to hear a lot about whether or not Missouri should participate in the Medicaid expansion in the coming months and now you know why the decision is so difficult!