A report funded by the Robert Wood Johnson Foundation, as part of Affordable Care Act (ACA) Implementation--Monitoring and Tracking series, examines progress in implementing selected Medicaid provisions in 10 case study states. The report finds that although all 10 are working on many different fronts to prepare for the 2014 expansions, only two are expected to fully expand Medicaid before 2014.

Prepared by researchers at the Urban Institute, the report reviews state progress in the following categories:

• Modernizing Medicaid eligibility and enrollment systems. The ACA calls for major updates to states' information technology systems in order to provide a highly automated, user-friendly enrollment and eligibility system. To date, all 10 states are pursing efforts to modernize and integrate their systems and are taking advantage of the ACA's enhanced federal match.
• Aligning payment for dual eligibles. Nearly all 10 study states are working to design and implement delivery and payment models that align care for persons eligible for both Medicaid and Medicare.  
• Early Medicaid expansion options. The ACA creates opportunities for states to cover low-income adults in advance of the 2014 expansion. Across the country, seven states and D.C. have taken advantage of the early expansion provisions, including two of the 10 case study states—Colorado and Minnesota.
• Basic Health Program (BHP). At the time of the site visit interviews, none of the 10 states had made an official decision about whether to create a BHP—an optional program to offer subsidized coverage for low-income individuals.

This report is one of a series papers focusing on ACA implementation issues uncovered in Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island and Virginia.