On June 28, 2012, the Supreme Court rendered an opinion on the constitutionality of the Patient Protection and Affordable Care Act (ACA). One major outcome of the Supreme Court's decision was to give states the ability to opt out of the Medicaid expansion while not jeopardizing current federal funding levels for existing Medicaid programs. The original text of the ACA would have taken federal Medicaid support away from those states that did not expand enrollment eligibility, but the Supreme Court decision ruled that the ACA violated the prohibition of federal coercion upon states. As of July 2013, 23 states plus the District of Columbia are moving forward with Medicaid expansion, 21 states are not moving forward, and six states are still debating the option. This article discusses the impact on existing state Medicaid programs, which will vary by state. 

Originally published in Health Watch, October 2013.