Medicaid Expansion

The Affordable Care Act (ACA) provided for a significant expansion of the Medicaid program, starting in 2014.

According to the law, the Medicaid program was to be expanded to provide eligibility to all citizens under age 65 with income below 133% of Federal Poverty Level (an estimated 16 million individuals).

The law also removed prior eligibility requirements that restricted coverage to “disabled” patients. This provision is an important development for many patients with HIV who need coverage, but have not yet progressed to a state of disability.

This expansion was expected to significantly increase access to the program to millions of low-income Americans, including many people with HIV.

However, the Supreme Court’s ruling in June of 2012, changed how that provision will be implemented in the states. Learn more about the Supreme Court’s decision.

The Court’s decision left the implementation of the Medicaid Expansion provision uncertain.  The law still provides for the expansion, however, the Court ruled that the federal government cannot force states to expand the program through a penalty of loss of all Medicaid funding.

In light of the ruling, some state lawmakers have declared that they will not proceed with the Medicaid Expansion in their state. Other states plan to proceed with the expansion as prescribed in the law. Still other states are undetermined. Learn more about what is happening in your state in our Health Reform in Your State section.

States who take up the Medicaid Expansion will now be eligible for a 1% increase in FMAP matching for preventive services. A list of services eligible for this increased coverage can be found here.

Learn more about how the Medicaid Expansion has affected the Ryan White funded care for people living with HIV/AIDS here.

In July 2013, CMS released the final rule for the Expansion and Exchange.