Repeal of the ACA Medicaid Expansion: Critical Questions for States
Jocelyn Guyer, Deborah Bachrach, Patricia Boozang, and Cindy Mann, Manatt Health
Updated as of December 22, 2016
As we approach the beginning of a new presidential administration, there has been continued debate regarding the future of the Affordable Care Act (ACA), much of which has focused on the marketplaces, the mandate, and health insurance reforms such as the ban on insurers’ blocking coverage to those with pre-existing conditions. A potential elimination of the law’s Medicaid expansion to low-income adults and other ACA Medicaid provisions, however, would have far-reaching implications for states and the Medicaid program. This issue brief, developed by Manatt Health, provides a series of questions and answers on the potential repeal of the Medicaid expansion, reviewing available information, and highlighting critical questions that states will want to consider as Congress and the incoming Administration continue to debate when and how to repeal the ACA.
On March 10, 2025, the Centers for Medicare & Medicaid Services released a proposed regulation that makes several policy and operational changes to the Affordable Care Act Marketplaces and insurance rules. This expert perspective reviews provisions of the proposed rule to assess their impact on State-Based Marketplaces and state insurance regulators.
Congress is considering a variety of federal policy changes that will have significant impacts on the Medicaid program, widely expected to reduce enrollment and federal Medicaid funding to states. A variety of state-level estimates have been released, which can be helpful for states as they consider how various policy proposals might impact their Medicaid programs. This expert perspective highlights state agencies that have estimated and quantified the potential impacts of various proposals on enrollment and spending. SHVS will continue to regularly monitor published estimates from states and update this expert perspective.