A trio of Democratic senators introduced a bill on Wednesday that would give states that recently expanded Medicaid the same federal funding as those that previously expanded. The legislation from Democratic Sens. Mark Warner and Tim Kaine of Virginia and Doug Jones of Alabama comes as more red states are considering expansion.
"It's crazy that for so many years, Virginia taxpayers were footing the bill for states that had already expanded Medicaid," Warner said in a statement.
So far 33 states and the District of Columbia have expanded Medicaid since the expansion was implemented in 2014 and three other states (Idaho, Utah and Nebraska) that passed a ballot measure to expand it. There are 14 states that haven't expanded Medicaid under the Affordable Care Act.
There have been 12 states, including Virginia, that did not expand Medicaid in 2014 but have expanded since then.
The States Achieve Medicaid Expansion (SAME) Act of 2019 would ensure those 12 states get the same federal funding as a state that originally expanded.
Under the ACA, a state can choose to expand Medicaid to all individuals up to 138% of the Federal Poverty Level.
From 2014 to 2016, the federal government picked up the full cost of the expansion. After 2016, the contribution started to decline. In 2020, states will have to pay 10% of the cost of the expansion. But a state that expanded Medicaid after 2014 doesn't get the same matching rate. For instance, Virginia's Medicaid expansion went into effect in January of this year and the federal government is only picking up 90% of the tab.
"Under the bill, a state would receive three years of full federal funding, phasing down to a 95% Federal Medical Assistance Percentages (FMAP) in Year 4; a 94% federal contribution in Year 5; 93% in Year 6; and, 90% for each year thereafter," the release said.
The Obama administration sought to make the same deal to states on the fence for expansion. In the administration's 2016 budget, it proposed fully funding a state's expansion regardless of when they expanded. The proposal went nowhere in the GOP-controlled Congress at the time.
A Texas federal judge's December ruling invalidating the ACA could eliminate federal authorization and funding for Medicaid expansion. That would force states to shoulder the full price of covering people who would not qualify for coverage under pre-ACA criteria, rather than having the federal government pick up 90% of the cost.
The ruling strengthens the hand of Republicans pushing to add work requirements to any expansion program. It could even prompt officials in some of the 30 other states that have expanded Medicaid to reconsider their programs. Many states have statutory provisions automatically ending their expansion program if the federal government reduces its contribution.