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Medicaid expansion now rests in state hands; special needs community awaits

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As some of the rhetoric over the Affordable Care Act dies down, alarm is popping up over the issue the Supreme Court left open to the states.

Within the health-care law is a provision for Medicaid expansion whereby the states agree to expand coverage for Americans under the age of 65 who currently live in poverty and are uninsured. In exchange, the government will significantly increase the funding for states who go along with the Medicaid expansion plans that are detailed within the law.

The implementation of the law would create a significant expansion of the current programs, possibly reinstating coverage for those who fell victim to state governments balancing their budgets with cuts to Medicaid programs.

The Supreme Court ruling provides state governments protection from “coercion” by the federal government. The way the law reads now, each state can ultimately reject the expansion mandate and forgo the federal funds associated with coverage expansion. The federal government cannot withhold funding for non-related issues should a state choose to reject the Medicaid expansion mandate. Lyle Denniston wrote an article for the SCOTUSblog explaining more about this particular part of the Supreme Court ruling.

Initially, the trending thought was that only a few states (if any) would turn down the new Medicaid funding.

According to a story this morning on NPR's Morning Edition, Mississippi may be the first state to publicly announce they are very seriously considering rejecting the federal Medicaid money. The reason cited is a claim that their portion of the expanded services would be too expensive even after including the federal funding they would receive.

State governments are no doubt furiously crunching the numbers to support whatever decision they ultimately make.

Will states like Arizona swallow their pride and go along with the expansion?

Of course they could cross their arms, turn their back, stomp one foot and say “nuh uh!” or “I’m NOT gonna!” or there is the best one: “You can’t make me!”

Two years ago, Arizona balanced the state budget with significant cuts to programs providing services for families raising little ones with a wide variety of disabilities.

These are interesting times, indeed. It would seem that once again, the fate of the special needs community in Arizona is resting in Jan Brewer’s hands.

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