Governors divided on Medicaid expansion, creating uncertain fiscal forecast for long-term care operators

Obama and healthcare reform lawmakers

There are likely to be notable gaps in Medicaid coverage through the nation when major parts of the Affordable Care Act go into effect on the first day of 2014, according to a New England Journal of Medicine study released Wednesday.

Researchers analyzed U.S. governors' views on Medicaid expansion to cover adults with family incomes equal to or less than 138% of the federal poverty level. The Supreme Court, in its June decision, said states could make the expansion optional. The NEJM findings were based on public statements and documents from June to early December, a month after the re-election of President Barack Obama.

Some experts predicted that an Obama victory would lead to swift, widespread acceptance of Medicaid expansion, but 13 Republican governors continue to oppose expansion, and 17 governors, including two Democrats, are undecided. The expansion of Medicaid is being viewed warily by long-term care operators, who worry senior beneficiaries may receive less coverage to offset the cost of more people on the rolls.

Almost all of the state governors who won't expand cited state budget impacts, while most undecided governors (75%) name uncertainty their biggest concern, according to the study.

Pennsylvania has the highest national per-capita Medicaid spending for elderly long-term care users, according to a Kaiser Health brief released Tuesday. The state's Republican governor is undecided on expansion. 

Some states with relcalcitrant governors may see Medicaid expanded through the legislature, researchers noted.