Many states are considering their options in the wake of a seemingly favorable Supreme Court ruling. The nation’s highest court ruled that Congress exceeded its reach when it threatened states with a total Medicaid funding cutoff if they failed to participate in an expanded Medicaid program.
While such participation is now optional, “Governors will be under intense pressure from Medicare and Medicaid advocates to expand eligibility,” said Avalere Health Senior Vice President Bonnie Washington in a Friday webinar discussing the implications of Supreme Court’s decision.
States now have two options: one is to move forward with expanding the Medicaid rolls, since the federal government has agreed to pick up the entire tab for three years, followed by 95% of the cost in 2017 and 90% in 2020. The other is for a state to stick with its current Medicaid program, since the high court said that the federal government could not cut existing funding if the state declined to expand.
With 11 gubernatorial races in 2012, it’s hard to know how all states will go, Washington said. But with other programs, particularly from the Center for Medicaid & Medicare Innovation, Avalere Director Carly Kelly said it is full steam ahead.
“CMS [the Centers for Medicare & Medicaid Services] has announced that it plans to enroll 2 million dual eligibles into models they have proposed for integrating care,” she said. “This could quickly turn into a nationwide shift in how duals receive care.”
Additionally, Avalere noted that states are varying in adoption of accountable care organizations: While New York and California each have eight and a handful of states have four, others don’t have any.