Justice John Roberts

The Supreme Court’s historic 5-4 Affordable Care Act decision clarifies insurance rules. But the controversial verdict appears to make Medicaid’s requirements and boundaries less certain than ever.

Essentially, the court found that while the federal government can incentivize states to expand Medicaid coverage, those that reject the offer cannot be penalized.

In the wake of this ruling, many providers are left grappling with disturbing Medicaid-related questions. For example, could states legally cut nursing home residents from their Medicaid rolls? Could states choose to discontinue reimbursement for higher-cost long-term care services? And could states that opt to participate in an expanded Medicaid program back out later on? So far, these and other matters remain unresolved.

Already, several Republican governors have said they plan to trim Medicaid services as soon as possible.