Most states are making the Medicaid application process easier as they prepare for implementation of the Affordable Care Act, according to a recently released study from the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families.

The ACA mandates that all states must offer online Medicaid enrollment as of January 2014. Every state except Pennsylvania, Michigan and Utah has begun work or submitted a planning document to upgrade its Medicaid eligibility system, researchers found. Overall, 37 states now offer online applications, after four states added online applications in 2012. Eight states added online renewal in 2012, bringing that total to 28 states.

In addition to expanding enrollment options, the ACA calls for states to provide greater assistance to prospective Medicaid enrollees. Currently, 23 states fund community-based assistors who help people sign up for Medicaid and 47 states offer toll-free telephone assistance, according to the report, which was released Wednesday.

The Supreme Court ruled in June that Medicaid expansion is optional, and many governors have expressed reservations. Making the application process easier is believed to allow more people — including seniors — to enroll under expanded Medicaid. While expanding eligibility is intended to broaden access to care, some LTC operators fear expansion could lead to cost-shifting that would compromise coverage for seniors.