Magazine article Clinical Psychiatry News

Expanding Medicaid

Magazine article Clinical Psychiatry News

Expanding Medicaid

Article excerpt

Starting in 2014, the Affordable Care Act requires states to offer Medicaid coverage to individuals under age 65 who earn less than 133% of the poverty level (about $29,000 for a family of four). While a few states already cover people who fall into this category, for most states this would be the first time that Medicaid coverage was available to nondisabled adults without children.

However, it remains unclear how many states will expand their Medicaid programs. In June, the Supreme Court found that Congress had overstepped its powers when it mandated the expansion. But the high court also said the expansion could move forward if states were given the opportunity to opt out and simply forfeit the associated federal matching funds.

The Congressional Budget Office estimates that 11 million people will gain Medicaid coverage; that's compared with a projected 17 million before the Supreme Court decision.

Dr. David L. Bronson, president of the American College of Physicians, explained the possible impact of the Supreme Court's ruling and the ACP's views on the Medicaid expansion.

CLINICAL PSYCHIATRY NEWS: Now that the Supreme Court has made the Medicaid expansion optional for states, what is the implementation likely to look like across the country?

Dr. Bronson: We feel the implementation will be challenging in some states. years to get all the states participating. We're hopeful that within a few years, all of the states will participate.

CPN: If Medicaid expansion ends up being a patchwork, what will that mean for patient access?

Dr. Bronson: Access will depend on where you live. That will really be a very dysfunctional system.

CPN: The ACA calls for covering low-income childless adults for the first time in many places. Is this a population that is currently falling through the cracks?

Dr. Bronson: Absolutely. This is a major gap in the current coverage system. This is a vitally important group to get covered. The practical difference is that if these people can be covered, they hopefully would be able to have their chronic medical problems managed, reducing the burden on the entire health care system. They would be a lot healthier because they would avoid complications of their chronic conditions. It would also help prevent both premature death and disability and all the health care expenses associated with sickness and disability. It's really a big deal.

CPN: Will the expansion of Medicaid guarantee access to care, or will low reimbursement for physicians cancel that out in some cases? …

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