Implications and Options for State-Funded and Medicaid Expansion Coverage Programs Under Health Reform


A number of states and the District of Columbia currently administer health coverage programs for low-income uninsured individuals who either exceed maximum Medicaid income eligibility thresholds or who are not categorically eligible for the Medicaid program—such as childless adults. These programs were created using Medicaid state plan authority, Medicaid waivers, state-only funds or a combination of mechanisms. Examples of such programs are the Alliance program in the District of Columbia, MinnesotaCare in Minnesota and Basic Health in Washington.

In anticipation of full implementation of health reform on January 1, 2014, states that administer these programs have important decisions to make, as the majority of individuals currently covered through these programs will be eligible for other coverage pursuant to the Patient Protection and Affordable Care Act (ACA), depending on whether states go forward with the Medicaid expansion.

This issue brief looks at 11 existing health coverage programs in six states and documents the legal, technical and policy issues the states are already addressing, or need to address, as they review options for transitioning program enrollees to new coverage options. It also presents possibilities for new uses of state dollars freed up by the infusion of federal funds in 2014.