Political, legal battles heat up over expansion
With congressional action to repeal the Affordable Care Act off the table in 2018, the Trump administration and the states engaged in a tense push and pull through the year between expanding, not expanding and limiting Medicaid eligibility. The CMS set up the Medicaid expansion battle in January by inviting states that extended benefits to low-income adults under the ACA to impose work requirements, premium payments and other conditions on eligibility. As of Dec. 7, five states gained approval to implement work requirements and another 10 had waivers pending with the CMS, according to the Kaiser Family Foundation.
But the future of work mandates, and of the Medicaid expansion as a whole, remained up in the air at year-end. Legal challenges to waivers issued to Arkansas and Kentucky are making their way through the court system and experts expect the U.S. Supreme Court to ultimately decide the issue. The ACA’s fate was also in the hands of the courts. A federal judge in Texas is set to rule in a lawsuit filed by 20 Republican attorneys general, led by Texas’ Ken Paxton, seeking to invalidate the entire Affordable Care Act, including its Medicaid expansion.
Other important Medicaid policy developments in 2018 were more mundane. The CMS issued a proposed rule in November giving states greater flexibility in regulating Medicaid managed-care plans, which now cover nearly 70% of all Medicaid beneficiaries.