Medicaid “Early Opt-In” States

Lynn A. Blewett, Principal Investigator

February 06, 2013

February 5, 2013: The Affordable Care Act (ACA) gives states the option to expand Medicaid to 138 percent of the Federal Poverty Level beginning in January 2014, but states can also choose to expand earlier using either a new state plan option and/or a Section 1115 waiver (see text box below). I can never remember which states (besides Minnesota of course) plus DC have taken advantage of the opportunity expand Medicaid before 2014 – the so-call “early opt-in” states. But the Kaiser Family Foundation (KFF) does excellent work keeping up on all the ACA-related changes to date, tracking this information on the Medicaid/CHIP portion of their website for quick and easy reference. KFF also provides a thorough synopsis of early expansion efforts as of May 2012 in this brief.

A Summary: Current Status of Early Expansion Efforts

As of January 2013, seven states and the District of Columbia have been approved to exercise the early expansion option—one using a State Plan Amendment (SPA), five using a Section 1115 Waiver, and two using both an SPA and a waiver (see table below). Each of the early expansion states and DC already had some type of state or county-funded program for low-income uninsured adults, and the early opt-in allowed them to cover some or all of the enrollees in these programs under Medicaid prior to 2014 and receive matching funds from the federal government for a portion of their costs through the Federal Matching Assistance Percentage (FMAP). The FY 2010 through 2012 FMAPS for each of the early expansion states are included in the table, along with the most recent early expansion enrollment numbers that are available online.

Let me know if you find new enrollment data and we will add it here.

*Coverage limited to St. Louis County

Sources

Kaiser Commission on Medicaid and the Uninsured. May 2012. “How is the Affordable Care Act Leading to Changes Today?” State Adoption of Five New Options.” Washington, DC: Kaiser Family Foundation. Available at http://www.kff.org/medicaid/upload/8312.pdf

Centers for Medicare and Medicaid Services. “Section 1115 Demonstration List.” Accessed January 15, 2013. Available at https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/index.html

Department of Health and Human Services. November 2010. “Federal Financial Participation in State Assistance Expenditures; Federal Matching Shares for Medicaid, the Children’s Health Insurance Program, and Aid to Needy Aged, Blind, or Disabled Persons for FY 2012.” Available at http://aspe.hhs.gov/health/fmap12.shtml.

Enrollment Notes

CA – October 2012 total monthly enrollment for all participating counties, see http://www.dhcs.ca.gov/provgovpart/Documents/LIHP/12%2019%20October%202012%20Enrollment.pdf

CT – January 2012 enrollment, see http://www.kff.org/medicaid/upload/8312.pdf;

CO – Enrollment is capped at 10,00 and there is currently a waitlist; waitlisted applicants are included in a random selection process each month, see http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheader=application%2Fpdf&blobkey=id&blobtable=MungoBlobs&blobwhere=1251809077998&ssbinary=true

DC- January 2012 enrollment, see http://www.kff.org/medicaid/upload/8312.pdf

MN – July 2012 enrollment in Medical Assistance (i.e., Medicaid) or adults without children under SPA , see http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_FILE&RevisionSelectionMethod=LatestReleased&Rendition=Primary&allowInterrupt=1&noSaveAs=1&dDocName=dhs_id_016343 ; November 2012 enrollment for adults MinnesotaCare under adults without children waiver, see http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_FILE&RevisionSelectionMethod=LatestReleased&Rendition=Primary&allowInterrupt=1&noSaveAs=1&dDocName=dhs_id_016345

MO – September 30, 2012 total enrollment, see http://www.dss.mo.gov/mhd/general/pdf/draft-gateway-extension-request.pdf

NJ --December 2012 General Assistance enrollment, see http://www.state.nj.us/humanservices/dmahs/news/reports/enrollment_2012_12.pdf

WA—Q3 2012 rolling quarterly average of Basic Health transition eligible enrollees and Medical Care Services transition eligible enrollees, see http://www.hca.wa.gov/hcr/documents/waiver/Trans_Bridge_Dem_Qtrly_Rprt_October_2012.pdf

State Plan Amendment vs. Section 1115 Waiver for Early Expansion

As noted in this Kaiser brief, states that expand coverage through the ACA’s SPA option must meet federal benefit and cost-sharing requirements and cannot cap enrollment. If states want to provide coverage that is not consistent with federal Medicaid rules, they can still use the 1115 waiver option, and the ACA allows them to receive additional federal Medicaid funds for this coverage for the first time (previously, states had to redirect existing federal Medicaid funds or create program savings to offset the cost of the coverage expansion under a 1115 waiver). For example, Minnesota used the SPA option to expand Medicaid eligibility to 75 percent FPL for low-income childless-adults and the 1115 waiver option to obtain additional FMAP for enrollees in MinnesotaCare, which has a more limited benefit set than what is provided under the state’s Medicaid program (i.e. the MinnesotaCare hospital benefit is capped at $10,000 per beneficiary per year).