Last week’s Supreme Court ruling on the affordable housing act has left it up to states to expand Medicaid coverage for the homeless. The Supreme Court ruling – on paper – allows states to opt out of Medicaid expansion entirely.
The National Alliance to End Homelessness has taken the position that states that opt out would be leaving large numbers of impoverished citizens without access to health coverage and passing up generous federal subsidies. In NJ the estimated number who would gain coverage is 450,000.
The subsidies consist of federal payment of 100 percent of costs for the first three years, phasing down over the next three years, but never going below 90 percent for the newly-covered group. In fact, a number of states have already moved to prepare for these and other Medicaid changes. Three jurisdictions – Minnesota, Connecticut, and Washington, DC – have already expanded coverage under an ACA provision for early implementation.
“Christie (also) said it might not be necessary for the state to expand Medicaid as the federal law envisions. ‘Medicaid is pretty well expanded … in New Jersey already because of the legacy of previous Democratic governors,’ he said. ‘I don’t think there is all that much to do.’ Christie’s comments suggested he planned to follow the lead of other Republican governors, who say they’ll refuse to implement any voluntary components of the law.”
State advocacy will matter even more in the next year. Homeless advocates in New Jersey should be paying careful attention to developments in the state and we have the opportunity to engage with mainstream advocates to take full advantage of the Medicaid changes in the ACA.
The New York Times features in the Business section of its website a chart showing how much a state would have to spend in dollar terms and as a percentage of its 2011 economic output to expand coverage between 2014 and 2019. New Jersey would need to spend $533 million but that expenditure would leverage $9.03 billion in federal funding.
The National Alliance has compiled a list of selected online resources for further information: