April 2021

April is Medicaid Awareness Month. For decades, Medicaid and the Children’s Health Insurance Program (CHIP) have been crucial sources of coverage for America’s children. Two-thirds of Americans have a personal connection to the program, either having received coverage themselves or knowing a friend or family member covered by Medicaid. And the Medicaid program remains widely popular as it has served as a lifeline for children and families during the coronavirus pandemic. As millions of families have lost their jobs and health care, Medicaid and the ACA have given them a place to turn to for comprehensive, affordable coverage. Unsurprisingly, by September 2020, Medicaid enrollment grew to an all-time high of 77 million Americans.  

Former President Trump spent years sabotaging the Medicaid program, which resulted in at least a million children losing Medicaid coverage. Now, President Biden is reversing course by signing the American Rescue Plan into law, historic legislation that includes the most significant health care expansion in a decade. The American Rescue Plan provides additional financial incentives for the 14 states that have not yet implemented Medicaid expansion, and it extends coverage to new mothers one year postpartum. These measures will have profound impacts on children and their families for years to come. 

Republican Efforts To Block Medicaid Expansion Reduces Children’s Coverage

Republican efforts to block Medicaid expansion continue to hurt children and their families. Research shows that when parents have access to Medicaid, children are more likely to be covered themselves. Alarmingly, the children’s uninsured rate in states that have rejected expansion is nearly double the rate in states that expanded the program. The Urban Institute estimates that more than 6 million people would enroll in Medicaid if the remaining 14 states implemented expansion, including some children who are currently eligible for the program but would newly enroll as their parents seek coverage. 

Medicaid Coverage Has Long-Term Benefits For Children 

New Research Shows Medicaid Prevents Children From Dying Young And From Developing A Disability As An Adult. “Minneapolis Fed economist Andrew Goodman-Bacon recently dropped a stone-cold classic of the genre, examining how the rollout of Medicaid in the late 1960s affected people who were children at the time. If you got health insurance through the program as a child, he found, you were less likely to die young; you were likelier to be employed and less likely to have a disability as an adult; and all these benefits actually wound up saving the government money.” [Vox, 3/25/21] 

• Medicaid For Children “Pays For Itself.” “It helps so much, in fact, that it saves the government money in the long term. The fiscal benefits of the policy to the government, Goodman-Bacon concludes, amounted to about $200 billion (in 2017 dollars) if you calculated the net present value in 1965, compared to a coverage cost of roughly $92 billion.” [Vox, 3/25/21] 

Medicaid Helps Children Stay Healthy, Leads To Long-Term Benefits For Children When They Grow Up. “Medicaid coverage has a significant positive impact not only on children’s health, but also on their educational attainment and job earnings. Children covered by Medicaid during their childhood have better health as adults, with fewer hospitalizations and emergency room visits, research shows.” [Center on Budget and Policy Priorities, 4/18/17]

Thanks To Medicaid, Students Have Access To The Resources They Need To Focus In School. “Under [Medicaid’s Early Periodic Screening Diagnostic and Treatment (EPSDT)] benefit, children and adolescents under the age of 21 have guaranteed access to a robust set of comprehensive and preventive health services, including regular well-child exams; hearing, vision, and dental screenings; and other services to treat physical, mental, and developmental illnesses and disabilities. The EPSDT benefit also covers medically necessary supplies and equipment that help students in schools, such as hearing aids, eyeglasses, wheelchairs, and other assistive technology to help students hear and see.” [Center on Budget and Policy Priorities, 4/18/17]

One Study Found Medicaid To Have A Larger Impact On Child Poverty Than All Other Tested Benefits Combined. “Medicaid is among the most effective anti-poverty programs…Medicaid had a larger effect on child poverty than all non-health means tested benefits combined. It is estimated to reduce child poverty by 5.3 percentage points.” [Georgetown University Center for Children and Families, 3/8/18]

Medicaid Helps Keep Families Out Of Debt. “Recent expansions in Medicaid for children and adults correspond with a decline from 2011 to the first half of 2016 in the share of families reporting problems paying medical bills. The percentage of poor and near poor children and adults who were in families having problems paying medical bills decreased by almost 30 percent…Health care costs are consistently found to be one of the most significant drivers of bankruptcies. One study estimated that more than 60 percent of all bankruptcies in 2007 were due to medical costs.” [Georgetown University Center for Children and Families, March 2017]

The ACA’s Medicaid Expansion Helps Children Gain Access To Care

After the Affordable Care Act expanded access to Medicaid, the children’s uninsured rate fell to an all-time low. Research confirms expanding access to Medicaid for parents has had ripple effects for their children. At the same time, states that continue to reject expansion are limiting children’s health care access: 

When Parents Have Medicaid, Their Children Are More Likely To Have Regular Care. As summarized by Georgetown University’s Center on Children and Families, recent research finds that “Parents enrolled in Medicaid have children who are 29 percentage points more likely to receive a well-child visit. The relationship is strongest for families with household incomes between 100% and 200% [of the federal poverty line]. In these families, parents enrolled in Medicaid have children who are 45 percentage points more likely to receive a well-child visit.” [Georgetown University Center for Children and Families, 1/12/18]

Medicaid Expansion Led To Gains In Coverage For Children As Well As Parents. A study in Health Affairs found that “710,000 children gained public coverage when their parents enrolled in Medicaid between 2013 and 2015. If the remaining 19 non-expansion states expanded Medicaid, 200,000 additional children would gain health coverage through existing programs. The effect was largest among children whose parents gained Medicaid eligibility through the expansion.”  [Georgetown University Center for Children and Families, 1/12/18]

The Children’s Uninsured Rate In States That Have Rejected Expansion Is Twice The Rate In States That Expanded The Program — And That Gap Is Growing. “Growing numbers of uninsured children are concentrating in states that have not expanded Medicaid. Between 2016 and 2019, the child uninsured rate in non-expansion states grew at nearly three times the rate of expansion states. Non-expansion states saw their child uninsured rate jump from 6.5 percent to 8.1 percent during the period examined while expansion states saw it increase from 3.5 percent to 4.1 percent (see figure 3 ). Moreover, two non-expansion states, Texas and Florida, were responsible for 41 percent of the coverage losses for children over the three-year period.” [Georgetown Center For Children And Families, 2/17/21]

More Than 528,000 Americans Got Covered in First Six Weeks

Washington, DC — Today, the Centers for Medicare and Medicaid Services released a report showing more than 528,000 Americans signed up for insurance through the Affordable Care Act Marketplace during the first six weeks of the special enrollment period President Biden enacted after taking office. According to Politico, “HHS data suggests a more diverse set of enrollees during this time period than in previous years. About 17 percent of sign-ups came from Black Americans, compared to 11 percent in 2020 and 2019. A larger proportion of lower-income Americans have bought plans for the first time compared to previous years.” In response, Protect Our Care Chair Leslie Dach issued the following statement:

“These numbers show that Americans need and want affordable health insurance, and thanks to President Biden and the Democrats in Congress, they can get it. The American Rescue Plan made health insurance more affordable for millions, and because President Biden is promoting his extended special enrollment period for the federal Marketplace, more and more Americans are learning they have access to low or zero premium coverage thanks to the new law. These monumental steps taken by President Biden and Democrats in Congress are already saving Americans money and making them healthier — both especially important as we continue to battle this pandemic.”

April is Medicaid Awareness Month, and the Republican lawmakers in the states that have not yet expanded Medicaid now have even more reason to do so. In addition to taking bold steps to combat the COVID-19 pandemic, the American Rescue Plan includes robust incentives for the 12 states that have rejected Medicaid expansion under the Affordable Care Act (ACA). Despite the overwhelming benefits of Medicaid expansion, Republicans have spent years undermining the ACA and its expansion of Medicaid at every turn, blocking millions from coverage. Yet the program has become increasingly popular, with voters in Missouri and Oklahoma approving expansion through ballot initiatives just last year. Recent polling from Data For Progress confirms broad support for expansion in key holdout states: 

Medicaid expansion has always been a great deal for states; under current law, the federal government covers 90 percent of the cost for expansion. However, under the American Rescue plan, the remaining holdout states would receive an additional 5 percent increase in the federal funding match for their traditional Medicaid programs for two years — more than enough to cover each states’ cost for expansion. Local headlines make clear this deal is just too good to pass up. 

HEADLINES: 

(AL) Associated Press: Alabama Sizing Up Medicaid Expansion.“Alabama Gov. Kay Ivey and legislative leaders said they are reviewing details of the nearly $2 trillion coronavirus relief package that includes new financial incentives for the states that have opted against expanding Medicaid to provide health coverage for more low-income Americans. A spokeswoman for Ivey said the governor is ‘open to the discussion’ on expansion but that state leaders need additional information about the long-term cost projections.”  [Associated Press, 3/21/21] 

(AL) The Birmingham News: ‘We Could Call It KayCare’: Alabama Democrats Push Governor For Medicaid Expansion. “Several Democratic lawmakers are pushing Alabama Gov. Kay Ivey to accept more than $900 million in the COVID stimulus bill to expand Medicaid to the state’s low-income adults. ‘I don’t care whether we call it Obamacare,’ said Sen. Bobby Singleton, D-Greensboro. ‘We could call it Kaycare. It could be Alabama Health Care. But we need to expand Medicaid and the time to do it is right now.’” [The Birmingham News, 3/16/21] 

(AL) Alabama Rise: 69% Of Alabama Voters Support Medicaid Expansion, New Poll Finds. ”Sixty-nine percent of Alabamians, including 64% of Republican voters, support expanding Medicaid when told about arguments for and against the idea, according to a new poll that the Cover Alabama Coalition released Wednesday…Both Republican and Democratic respondents were more likely to support Medicaid expansion with increased financial support from the federal government. A U.S. House bill would offer a dramatic increase in federal incentives for states like Alabama to expand Medicaid. If enacted, the legislation would provide an additional $940 million in federal money to Alabama over two years if the state expanded Medicaid.” [Alabama Rise, 2/17/21] 

(FL) WUSF: Medicaid Expansion Could Help Florida Overcome Budget Deficit, Advocate Says. “This year, the state is facing a $2 billion budget deficit, and lawmakers already are considering cuts to Medicaid payments. At the same time, Congress is considering expanding incentives that would provide billions of dollars to Florida and 11 other holdout states to expand Medicaid. Advocates say these incentives could help Florida overcome its budget deficit.” [WUSF, 3/3/21] 

(FL) WMFE: Explaining The American Rescue Plan’s $3.5B Incentive To Expand Medicaid In Florida. “Democrats are using the 11th anniversary of the Affordable Care Act to renew calls to expand Medicaid in Florida. The ACA originally called on states to expand Medicaid to all adults up to 133 percent of the federal poverty line. But Florida is one of 14 states that didn’t expand Medicaid. Now, the $1.9 trillion dollar American Rescue Plan offers a new incentive: It would cover 90 percent of the cost to enroll an estimated 800,000 Floridians in Medicaid. And it would increase the federal pay rate for all Medicaid enrollees for the next two years. Together, that would bring an estimated increase of $3.5 billion dollars into Florida.” [WMFE, 3/23/21] 

(FL) Florida Politics: Democrats Lobby Florida Legislature To Expand Medicaid, Grab New Federal Dollars Under COVID-19 Relief Bill. “Florida Democrats and health care advocates are pushing the GOP-controlled Legislature to take advantage of new federal incentives to expand Medicaid in Florida…A new provision in the American Rescue Plan provides even more federal dollars to encourage Medicaid expansion in any state that has not already expanded those benefits. Florida is one of 12 states that falls into that bucket. The additional federal dollars would trickle in for two years, and could cover another 5% of costs for people covered.” [Florida Politics, 3/23/21] 

(FL) Palm Beach Post: Ted Deutch, New HHS Chief Tout Stimulus, Call On Florida To Expand Medicaid. “Then there are the new incentives to expand Medicaid in the state, Deutch and others said. Florida could end up with more than a billion dollars in federal funding above the cost of paying for broader Medicaid enrollments because of matching funds to help pay for existing enrollees on top of payments for expansion. As a result, the state would reap additional dollars in addition to providing Medicaid health coverage for another 1 million Floridians if the federal program were expanded, said Leslie Dach of Protect Our Care.” [Palm Beach Post, 3/23/21] 

(GA) Georgia Recorder: Georgia Dems Urge State To Accept Sweetened Medicaid Expansion Deal. “Georgia Democrats called on the state’s GOP leadership to take advantage of new federal incentives to fully expand Medicaid that were baked into the $1.9 trillion COVID-19 relief package President Joe Biden signed last week. Georgia is one of a dozen states that did not expand Medicaid under the Affordable Care Act, with Republicans calling it too costly in the long run.” [Georgia Recorder, 3/15/21] 

(GA) Atlanta Journal Constitution: With Pandemic Relief Plan, Democrats Try To Spur Georgia To Expand Medicaid. “Republican leaders in Georgia have adamantly opposed expanding the program to cover more low-income adults, saying it would be too costly in the long run and deny state health officials flexibility. But the $1.9 trillion stimulus aims to make resistance harder by including an infusion of about $2 billion to the state to cover the full tab of Medicaid expansion for two years.” [Atlanta Journal Constitution, 3/11/21] 

(KS) Topeka Capital-Journal: Joe Biden’s COVID-19 Relief Bill Could Give Kansas An Extra $450M ― If It Expands Medicaid. “Kansas remains one of 12 states to not adopt provisions of the Affordable Care Act, which would expand Medicaid to at least 130,000 to 160,000 low-income people. But Congress is expected to pass its next COVID-19 relief package Wednesday, and national Democrats have tucked in a section aimed at enticing states that haven’t expanded Medicaid to do so.” [Topeka Capital-Journal, 3/10/21] 

(KS) The Kansas City Star (Editorial): Kansas, You Are Out Of Excuses. COVID Relief Would Pay For Expanding Medicaid. “Year after year, stingy state legislators have said Kansas simply can’t afford Medicaid coverage for another 165,000 residents. Too bad about the closing of rural hospitals, they said. Such a shame about poor health outcomes in urban areas. It was just too expensive, they argued. But the recent passage of Congress’ pandemic relief package has rendered that argument moot. The bill provides more than $16 billion for states that haven’t expanded Medicaid, including Kansas, making it essentially cost-free for the next two years.” [Kansas City Star, 3/17/21] 

(MS) Clarion Ledger: Mississippi Insurance Commissioner: What Medicaid Expansion Would Mean For The State. “The federal pandemic relief bill contains a big incentive for states that haven’t expanded Medicaid. Mississippi is one of 12 states holding out on the expansion. State Insurance Commissioner Mike Chaney says currently the federal government pays about 80 cents on the dollar for Medicaid coverage. If Mississippi were to expand, that amount would increase to 95 cents. Chaney says Medicaid expansion could provide health care coverage options for those who do not currently qualify under the Affordable Care Act.” [Clarion Ledger, 3/30/21] 

(MS) Northeast Mississippi Daily Journal (Editorial): Expanding Mississippi Medicaid Makes More Sense Than Ever. “The case for expanding Medicaid got a lot stronger this month, to the point that most any reasonable, rationale consideration would conclude that now is the time for Mississippi to do so…But the recently passed COVID-19 relief bill made the offer even more enticing by including billions of dollars for the 12 states that have not expanded Medicaid. In addition to covering 90% of new Medicaid enrollees for two years, the federal government has agreed to cover approximately 5% of the cost for current enrollees — an estimated $16.4 billion if all 12 states took the deal.” [Northeast Mississippi Daily Journal, 3/28/21] 

(NC) Charlotte Observer (Editorial): Medicaid Expansion Comes Knocking Again In NC. This Time It’s A Better Deal. “Now President Joe Biden is making a pitch to North Carolina and 11 other holdout states in an effort to extend health insurance to millions of people who are braving the pandemic without it. Biden’s $1.9 trillion COVID-19 relief package has passed by the House and is awaiting a Senate vote. The plan provides an incentive for states to expand Medicaid by temporarily increasing federal Medicaid payments by 5 percent for two years for states that newly expand Medicaid.” [Charlotte Observer, 3/1/21] 

(NC) WRAL (Editorial): Take The Money, It’s Ours. Expand Medicaid. “There are no good reasons for North Carolina not to expand Medicaid coverage to as many as 650,000 North Carolinians who now lack affordable access to health care…The federal COVID-19 relief legislation that appears to be headed to the president offers North Carolina between $1.7 billion and $2.4 billion in ADDITIONAL federal medical assistance percentage (FMAP) funds over two years – that would be on top of the cost of covering Medicaid expansion.” [WRAL, 3/10/21]

(NC) WRAL (Editorial): Expand Medicaid Now. It’s GOOD Policy. “As has been pointed out repeatedly, there is Medicaid expansion funding in the recently enacted federal COVID-19 relief legislation. Those are dollars – estimated from between $1.7 billion to $2.4 billion — North Carolina taxpayers send to Washington and won’t come back without being used to help keep more North Carolinians healthy. It would provide a significant reduction in the uncompensated care costs hospitals have to shoulder for treating uninsured patients. Hospitals in Louisiana saw those costs reduced by a third as a direct result of that state’s expansion of Medicaid. Expanding Medicaid in the state would generate thousands more jobs and increase ‘business activity by $11.7 billion over three years, between 2020-2022. It’s money that could be spent on education, infrastructure and other needs.’” [WRAL, 3/17/21] 

(SC) Charleston City Paper: SC Has Big, New Incentive To Expand Medicaid To Cover 200K, But Will It? “State coffers could get $2.5 billion in new federal funding over two years if lawmakers get over longstanding political objections to expand Medicaid to cover about 200,000 residents without health insurance.  At present, many agree expansion is more of a possibility than a probability due to the state’s political climate. The new funding over two years would come from a 90% federal match of health insurance costs plus a new federal incentive of about $790 million with few strings attached, analysts say.” [Charleston City Paper, 3/25/21]

(SD) PBS NewsHour: Support For Medicaid Expansion Grows In South Dakota, One Of The Last Red State Holdouts. “South Dakota would wind up spending less on health care in the future by expanding Medicaid, because the federal government would pick up a larger share of the costs for services such as prenatal care for residents who are already enrolled in the program. Hospitals and clinics would also see a decline in uncompensated care costs for treating uninsured patients as more people without insurance enroll in Medicaid, health care experts said. Under the Affordable Care Act, the federal government would cover 90 percent of the costs for expanding the program to more people, leaving South Dakota to chip in just 10 percent of the additional funding. The pandemic relief bill Biden signed last week includes extra federal funding for states that haven’t yet expanded Medicaid if they choose to do so.” [PBS NewsHour, 3/16/21] 

(TN) Nashville Tennessean: Tennessee Republicans Open To Medicaid Expansion Talks As Biden Sweetens Deal. “Tennessee could offer TennCare coverage to hundreds of thousands of moderately poor residents while also saving as much as $900 million in state money over two years if lawmakers expand Medicaid under a sweetened deal proposed by the White House. These new incentives, offered by President Joe Biden’s coronavirus stimulus law, have prompted at least one prominent Republican leader to reconsider expansion after his party opposed it for a decade.” [Nashville Tennessean, 3/23/21] 

(TN) WKRN: Top Republicans Are Split On Medicaid Expansion Incentives That Could Top $1 Billion. “New incentives in the latest COVID-19 relief package will give Tennessee the option for millions of dollars to cover the healthcare cost of 300,000 Tennesseans if the General Assembly decides to expand Medicaid. Tennessee Democrats are renewing their hope that the state will expand Medicaid under new standards from the federal government.” [WKRN, 3/27/21] 

(TX) House Chronicle: Latest Covid Relief Bill Expands Aid For 3.9 Million Texans Living In Poverty. “The stimulus also includes another attempt at getting Texas to expand Medicaid, something Republicans in Austin have long resisted, suspicious that the federal government will eventually shift the costs of the program onto the state. An estimated 1.4 million uninsured Texans would be eligible for Medicaid if it were expanded. The stimulus boosts the federal share of the cost of expansion by 5 percentage points — a move pushed by U.S. Rep. Lizzie Fletcher, a Houston Democrat, who said the provisions are ‘vital to helping incentivize states like Texas and the others that have not expanded Medicaid to do so.’” [Houston Chronicle, 3/9/21] 

(TX) San Antonio Express-News (Editorial): On Medicaid, Texas Defies Logic, Fiscally And Morally. “There is simply no compelling reason for Texas to refuse to expand Medicaid, and yet here we are, stuck with the highest uninsured rate in the nation because the majority of Republican lawmakers just can’t go there. It is doubly tragic. The numbers speak for themselves. Before the pandemic, Texas had an uninsured rate of 18.4 percent. That’s almost certainly risen with unemployment in the time of COVID.” [San Antonio Express-News, 3/9/21]  

(WI) Wisconsin Examiner: Expanding BadgerCare In Wisconsin Could Become An Even Sweeter Deal. “Under [the] new COVID bill, $1.3 billion would be dangled in front of Wisconsin, but only if it expands Medicaid…U.S. House Democrats are trying again to entice holdout states, including Wisconsin, to expand Medicaid coverage with the prospect of billions of dollars in federal cash. This money would be on top of the already large net benefits the state would realize under existing law through expansion.” [Wisconsin Examiner, 2/11/21] 

(WI) Wisconsin State Journal: Report: Medicaid Expansion Could Mean $1.6 Billion More For State Over Next 2 Years. “Wisconsin could save more than $1.6 billion over the next biennium by expanding Medicaid, raising the stakes significantly on Republicans who remain steadfastly opposed to the move. The federal COVID-19 relief bill Congress passed Wednesday would provide Wisconsin more than $1 billion in new, temporary savings if the state adopts Gov. Tony Evers’ call for Medicaid expansion in the upcoming budget, according to a new report by the nonpartisan Legislative Fiscal Bureau.” [Wisconsin State Journal, 3/11/21] 

(WY) Casper Star Tribune (Editorial): It’s Time To Expand Medicaid In Wyoming. “Put simply, Medicaid expansion addresses a critical problem that has persisted in Wyoming. And it does so while also providing millions of dollars in revenue at a time when it’s badly needed. Viewing this reality through a nonpartisan lens reveals just how much our state can benefit. Opponents of expansion are out of excuses. The law is clearly not going anywhere. It’s not going to collapse under its own weight. And if there was a better, Wyoming specific solution, someone would have offered it by now.” [Casper Star Tribune, 3/14/21] 

(WY) Associated Press: Wyoming Edges Closer To Medicaid Expansion. “Although Congress has not yet passed the legislation, Biden’s strategy appears to be working. A key Wyoming Senate committee this week approved a measure that would extend Medicaid benefits to all poor adults—not just older adults, those with disabilities and pregnant women. The bill now moves to the Wyoming Senate floor. If it passes, the law would add about 24,000 Wyoming residents to the Medicaid rolls, according to estimates released by the state’s Department of Health last month.” [Associated Press, 3/9/21] 

(WY) Medicaid Expansion Bill Gains Approval In Wyoming House. “Wyoming lawmakers have attempted to expand health insurance for low-income residents through Medicaid expansion for nearly a decade, and each attempt thus far has been defeated, often early in the legislative process. House Bill 162 still requires two additional readings in the House before heading to the Senate. But several staunch opponents to expansion over the years are now in support of the effort. Those who have found themselves advocating for legislation they previously opposed include Rep. Steve Harshman, R-Casper.” [Casper Star Tribune, 3/22/21] 

Medicaid Awareness Month Will Feature Nationwide Events With Elected Officials, Storytellers, and Advocates Holding Republicans Accountable for Refusing Medicaid Expansion

Washington, DC — April is Medicaid Awareness Month, and Protect Our Care is kicking off a month of action by hosting dozens of events nationwide with elected officials, storytellers, and health care advocates. In addition, Protect Our Care will release polls on voters’ attitudes in four states that failed to expand Medicaid and a series of reports highlighting the benefits of Medicaid in specific communities. Protect Our Care will hold events throughout the month of April in Alaska, Arizona, Florida, Georgia, Maine, North Carolina, Ohio, Pennsylvania, Wisconsin, and West Virginia.

With the passage of the American Rescue Plan, Republican lawmakers who have refused to expand Medicaid have another chance to do the right thing for their constituents. During Medicaid Awareness Month, Protect Our Care is launching a campaign to push the Republican governors and state legislators in the 14 holdout states to accept the additional funds now available to them through the American Rescue Plan to expand Medicaid. The campaign — featuring a website and digital ads — will also hold Republicans in Congress accountable for their votes against the American Rescue Plan and their efforts to sabotage Medicaid at every turn. 

“Medicaid is vital for ensuring access to quality, affordable care, especially for communities of color. Unfortunately, even as the benefits of the program are clear, Republicans continue to attack Medicaid,” said Protect Our Care Executive Director Brad Woodhouse. “It’s time for Republicans to stop playing politics with their constituents’ health. By refusing to expand Medicaid in their states, Republicans are denying insurance to their most vulnerable populations — it’s almost criminal. The American Rescue Plan gives holdout states yet another opportunity to do the right thing. If they refuse they can expect to be held accountable.”

BACKGROUND:

How The American Rescue Plan Strengthens Medicaid Coverage

On March 11, President Biden signed the American Rescue Plan into law, historic legislation that includes the most significant health care expansion in a decade. After four long years of Republican efforts to sabotage the Affordable Care Act (ACA) and Medicaid, President Biden and Democrats in Congress are now working to expand coverage, lower costs, and reduce racial disparities in health care. 

In addition to providing affordable coverage options for millions of uninsured Americans through the ACA, the American Rescue Plan provides robust financial incentives for the 14 states that have not yet implemented Medicaid expansion. The legislation also includes important measures to strengthen Medicaid coverage and benefits. Medicaid has served as a critical safety net as millions have lost jobs and their employer-based health insurance during the pandemic. Unsurprisingly, Medicaid enrollment has grown to an all-time high of 77 million Americans. Between February and November 2020, states that expanded their programs saw a 22 percent increase in Medicaid enrollment. 

The American Rescue Plan: 

Incentivizes Medicaid Expansion. The American Rescue Plan includes an offer too good for Republican holdout states to turn down: In addition to covering 90 percent of the costs for the expansion population, the federal government would chip in an extra 5 percent for the traditional Medicaid population for two years. This translates to billions in additional dollars for the states — more than enough to cover the cost of expansion itself. Research confirms that Medicaid expansion increases access to care, improves financial security, and leads to better health outcomes. 

• Four million uninsured adults could gain coverage if remaining holdout states expand Medicaid. An estimated four million uninsured adults — including 640,000 frontline workers, 500,000 people with disabilities, and 926,000 older adults aged 50 to 64 — could gain coverage if the remaining holdout states adopted expansion. Importantly, people of color make up nearly 60 percent of this group. Additionally, research shows that Medicaid expansion helps increase coverage rates for children. 
• Even after paying the cost of Medicaid expansion, these states would receive an additional $9.6 billion in new federal funding that they could use to offset spending in other state programs or budget shortfalls. According to estimates from the Kaiser Family Foundation, the 14 states that have not yet implemented Medicaid expansion would receive $16.4 billion thanks to the enhanced federal match rate under the American Rescue plan, while the total cost of Medicaid expansion in these states would only be $6.8 billion.

Expands Medicaid Coverage To New Mothers One Year Postpartum. Women in the United States are more likely to die during childbirth than in peer nations, and Black women are three to four times more likely to die of complications related to pregnancy and childbirth compared to white women. A recent study from the Urban Institute found that 20 percent of uninsured new mothers skipped care because of cost, and half worried about not being able to afford medical bills. The American Rescue Plan works to address the maternal mortality crisis by enabling states to expand Medicaid coverage to new mothers 12 months postpartum. This is particularly important in non-expansion states, where many new mothers fall into the coverage gap. 

Includes Funding To Ensure Medicaid Patients Can Get COVID-19 Treatment & Vaccinates For Free. The American Rescue Plan includes federal funding to provide COVID-19 treatment and vaccines at no cost to Medicaid recipients. The ARP also gives 100 percent federal match funding to states that choose to provide vaccines and treatment to the uninsured without cost sharing. Efforts to increase vaccination will be especially beneficial in communities of color and hard to reach populations.

Invests In Medicaid Home- And Community-Based Services (HCBS). HCBS help seniors and people with disabilities live and age independently at home and in their communities. Under the American Rescue Plan, states will receive a 10 percentage point increase in federal matching funds through March 2022 to strengthen Medicaid HCBS. The American Rescue Plan also includes additional funding for Medicaid-certified nursing facilities experiencing COVID-19 outbreaks. 

Invests $8.5 Billion In Relief Payments For Rural Medicaid Providers. Rural hospitals have taken a serious financial hit during the pandemic. Per the Kaiser Family Foundation, “These funds are available to compensate for health care related expenses and lost revenues attributable to the pandemic for rural providers who diagnose, test, or care for individuals with possible or actual COVID-19.” 

Provides Additional Funds For Community-Based Mobile Crisis Intervention Services. The American Rescue Plan gives states the option to provide community-based mobile crisis intervention services with 85 percent federal matching funds for three years. These services help people experiencing issues with mental health and substance use disorder. 

Lifts The Medicaid Drug Rebate Cap. Eliminating the cap on prescription drug rebates that manufacturers pay to state Medicaid programs would bring significant savings to state budgets as they recover from the economic toll of the pandemic.