How does the Supreme Court ruling on the ACA affect Medicaid? How does the ACA affect the program?
The ACA had authorized the DHHS to withhold the federal share of financing as a penalty for states that refused to expand Medicaid. The US Supreme Court struck down this mandate. Consequently, states now had a choice to either expand or not expand their Medicaid programs without any penalty from the federal government.
The ACA requires coverage for legal residents under the age of 65 with income up to 138% of the FPL. States can no longer use the assets test. Federal matching will be provided at 100% for newly eligible individuals for 3 years (2014-2016), with a gradual reduction each year to 90% in 2020. Beneficiaries who were already in the Medicaid program, coverage for preventive services is at the discretion of the state. States have the option to establish Health Homes (not to be confused with home health care) for Medicaid beneficiaries who have chronic conditions, including serious and persistent mental health conditions.