HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Monday, December 10, 2012

ACA and Federal-State Partnerships

Historically, public benefit programs have fared better when provided through a federal program rather than a federal-state partnership. Medicare has been a better program than Medicaid for recipients in part because the federal government imposes a uniform standard for eligibility on all states. Under pre-ACA law, adults might lose Medicaid eligibility at income levels below 50 percent of the federal poverty level in some states while retaining Medicaid eligibility at income levels above the federal proverty level in other states. Similarly, when states set eligibility standards for food stamps during the first decade of that program, income thresholds varied from state to state, and residents in many counties were not eligible at all for the program.

ACA does much to address the uniformity problem with the Medicaid expansion that offers Medicaid to all persons with a family income up to 138 percent of the federal proverty level. However, as states are defining their essential benefits packages for plans sold on health insurance exchanges, we are starting to see the expected problems from the parts of ACA that retain a federal-state partnership model. When HHS decided that states would determine the specifics of their essential health benefit packages, it made state-to-state variation inevitable. And as the New York Times reported last week,coverage for acupuncture, hearing aids, infertility treatment, weight loss surgery and other services will vary from state to state.


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