Even states that sincerely want to meet the Medicaid eligibility expansion goals set out in the Patient Protection and Affordable Care Act of 2010 (PPACA) may have their work cut out for them.
Stanley Czerwinski and Carolyn Yocum, directors at the U.S. Government Accountability Office (GAO), give that assessment in a look at states' implementation of the PPACA Medicaid expansion provisions.
The U.S. Supreme Court recently drew attention to the Medicaid expansion provisions by holding that Congress had the authority to use new funding to encourage states to expand eligibility to individuals with incomes at or below 133% of the federal poverty level but could not prod states to expand eligibility to threatening to withhold existing funding.
GAO investigators looked closely at PPACA Medicaid provision implementation in 6 states -- Colorado, Georgia, Iowa, Minnesota, New York, and Virginia.
All of the states "are taking some steps to prepare for the Medicaid expansion, including assessing changes that need to be made to their existing eligibility levels and eligibility determination policies," and the states seem to like the fact that PPACA provides funding to help states replace outdated Medicaid computer systems, Czerwinski and Yocum write.
But the Centers for Medicare & Medicaid Services (CMS) is still working on some guidance on implementing the provisions, and state officials told the GAO they need help with matters such as understanding how to apply PPACA "modified adjusted gross income" eligibility determination rules, Czerwinski and Yocum say.
State officials also want more help with understanding what should go into Medicaid benefits packages and federal support for adults who are newly eligible for Medicaid, the GAO officials say.
"States also reported operational challenges that could affect their ability to meet Medicaid expansion and system development deadlines, such as lengthy state procurement processes, the complexities of developing new systems, coordination of multiple programs and systems, and resource limitations," the officials say.
"Concerted and cooperative efforts on the part of CMS and the states will be critical to meeting the implementation deadlines for the Medicaid expansion," the officials say.