State AGs Support Medicaid Expansion but Can’t Afford Existing Program

Last month, eleven states plus the District of Columbia filed an amicus brief with the Supreme Court supporting the Affordable Care Act, including a provision that will significantly expand Medicaid coverage, in a move that sharply contrasts with several states that are revamping or slashing their Medicaid programs and budgets as they struggle to remain financially solvent.

The state attorneys general, hailing from California, Connecticut, Delaware, Hawaii, Illinois, Iowa, New Mexico, New York, Oregon, Vermont, the District of Columbia, and the Virgin Islands, believe that healthcare reform is necessary.

“The Affordable Care Act is vital for states seeking to battle spiraling health care costs and gaps in coverage for those who need critical care,” said Maryland Attorney General Gansler in a statement about the filing. “Just as Congress can legally require truck drivers to purchase liability insurance, workers to contribute to Social Security, send our children off to war, or file an income tax return every April, so can Congress require the purchase of health insurance. As every state knows all too well, health care in America is in crisis and requires a national solution.”


While the attorneys general are showing their support for the Affordable Care Act through the amicus brief, filed in HHS v. Florida (No. 11-398), some of their states’ governors may not be on the same page about the impending expansion of Medicaid eligibility.

New Mexico Working to Slow Medicaid’s Growth Rate

New Mexico’s Governor Susana Martinez is currently seeking to overhaul her state’s program to slow the rate of growth in Medicaid enrollment, reports the SF Gate.


New Mexico’s Medicaid program accounts for 16% of the state’s budget this year, and costs the state’s taxpayers nearly $1 billion, the article reports. In response, the governor’s administration is proposing co-pays for Medicaid recipients who go to an emergency room for routine medical care, along with a couple other changes; it hopes to implement the revamped program by October of next year.

Illinois Cutting $2.7 Billion from Medicaid Program

In the Midwest, Illinois is facing what Governor Pat Quinn’s (D-Ill.) chief of staff termed the “toughest budget,” with Quinn’s proposal including a $2.7 billion cut from the Medicaid program, reports Bloomberg.

The state currently has a $9 billion backlog of unpaid bills; Bloomberg says that “Illinois’s unpaid bills may more than triple to $34.8 billion by 2017 unless lawmakers and the governor immediately bring Medicaid and pension spending under control,” according to a Chicago-based Civic Federation report.

A senior advisor to Gov. Quinn is also quoted as saying that the mounting cost of healthcare for the poor is “a recipe for the collapse of the Medicaid program.”

California Seeks to Revamp Medi-Cal, Slashes Budget

On the West coast, California remains embroiled in a battle with healthcare providers who are suing the state to prevent cuts to Medicaid reimbursements.

Governor Jerry Brown (D-Calif.) is seeking authorization from President Barack Obama to enact further cuts to Medi-Cal, the state’s Medicaid program, to help balance his state’s budget, reports the Sacramento Bee. While he hasn’t received authorization to do so, the governor has made bids to charge Medi-Cal recipients co-pays for prescription drugs, doctor visits, and other services.

The Supreme Court recently decided to forego a ruling about whether healthcare providers can sue the state to protest Medicaid reimbursement cuts, sending the case to the Ninth Circuit, with other states watching proceedings to see how it could impact them.

26 States Protesting Medicaid Expansion

The ACA requires states to expand Medicaid coverage to all individuals under 65 with incomes of up to 133% of the poverty level, compared to the current program, which covers people who meet state-designed assessments for functional need and certain financial standards.

The change is expected to increase enrollment by nearly 16 million by 2019.

A couple days before the 12 states mentioned above filed the amicus brief supporting the Affordable Care Act, 26 states asked the Supreme Court to bill’s mandatory state expansion of the Medicaid program, arguing that the federal government can’t force them to expand as it breaches states’ autonomy.

“While some individuals are exempt from the penalties designed to enforce the mandate, no state is exempt from the massive penalty—the loss of the entirety of funding under the single largest grant-in-aid programs for the states—and so Congress did not even contemplate the possibility of a state opting out of Medicaid,” attorney Paul Clement, who is representing the states, wrote in a brief to the court Tuesday, Politico reports.

Written by Alyssa Gerace