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Regulators are likely to give states flexibility when it comes to the Affordable Care Act’s Medicaid expansion, a Centers for Medicare & Medicaid Services official suggested Monday.

States can sign up to expand Medicaid as early as January 2014 or at any point after that, and states that have signed on to expand can exit the program if they are unhappy with it, explained Cindy Mann, director of CMS’ Center for Medicaid and Children’s Health Insurance Program Services. Mann spoke to lawmakers attending National Conference of State Legislatures annual meeting in Chicago Monday.

“We think that is consistent with the nature of the court’s decision to make it a voluntary program,” Mann said, according to a Bureau of National Affairs report. She said the U.S. Supreme Court envisioned “a truly voluntary expansion” of Medicaid.

The high court’s ruling on the Affordable Care Act made the law’s massive Medicaid expansion optional. The law calls for states to extend eligibility to people with incomes of up to 133% of the federal poverty level — an expansion that many Republican governors have rejected. Medicaid is the primary payer for the bulk of skilled nursing care provided in the United States.

Mann emphasized that while there were no Medicaid implementation deadlines, states would miss out on federal funds the longer they choose to wait.