States that have expanded Medicaid under the Affordable Care Act generally have seen gains in coverage, improvements in access to and affordability of health care, and net fiscal benefits, a growing body of research and data show.
At the same time, Medicaid expansion has not diverted coverage from traditional groups or significantly reduced state spending on other programs, the research shows, contrary to assertions by some critics of Medicaid expansion. For example, data do not support a relationship between states’ expansion status and Medicaid community-based long-term care services waiver waiting lists.
These are the key findings in a new issue brief from the Kaiser Family Foundation that summarizes the existing research as the debate intensifies over the costs and benefits of Medicaid expansion. Some studies look at 2014-2016, when expansion costs were 100 percent financed by the federal government, so savings estimates could change, but other studies anticipate net fiscal gains even after states begin to pay the state share of the expansion costs. Several more states are considering expanding Medicaid to cover low-income adults (some through ballot initiatives), joining 32 states and Washington D.C. that have already adopted Medicaid expansion.
Amid the renewed debate, some states, encouraged by the Trump Administration, are pursuing waivers to reshape their Medicaid programs with work or community engagement requirements that would lead to declines in enrollment and scale back Medicaid expansion coverage. The new brief highlights what the latest research shows about Medicaid expansion’s effects on coverage, access, affordability, health outcomes, economic measures, and work.