As currently structured, states have little freedom to target the enhanced matching funds associated with the expansion of Medicaid at the beneficiaries in greatest need of assistance
The collapse of the congressional Republican attempts to replace the Affordable Care Act have ensured that the broad expansion of Medicaid to low-income able-bodied adults is unlikely to be repealed. But nor have many additional states since leapt to expand their programs.
As currently structured, states have little freedom to target the enhanced matching funds associated with the expansion of Medicaid at the beneficiaries in greatest need of assistance. This has inflated the cost of the program's expansion, eroded incentives for work, and deterred non-expansion states from extending funds to address the most acute unmet needs.
The ACA initially required states to expand Medicaid to cover all able-bodied qualified residents in households earning less than 138 percent of the federal poverty level. The 2012 NFIB v. Sebelius Supreme Court ruling made this expansion of Medicaid optional for states. But, under the Obama administration, the associated coverage requirements remained largely an all-or-nothing deal – and one which 19 states have still not chosen to adopt.
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Chris Pope is a senior fellow at the Manhattan Institute. Follow him on Twitter here.
This piece originally appeared in Washington Examiner