CMS recently released the results of a study that analyzed the experiences of six “early expander” Medicaid states.  Following the passage of the Affordable Care Act (ACA) in 2010, these six states and jurisdictions—California, Connecticut, the District of Columbia, Minnesota, New Jersey and Washington—expanded Medicaid coverage to many of the individuals who will be eligible for Medicaid as of 2014 under the ACA.

The study’s authors gathered data and publicly available information and conducted interviews with senior Medicaid officials in each state.  The interviews focused on enrollment matters, stakeholder involvement and support, beneficiary impact, costs of expansion and administrative challenges.  According to the study, the most frequently discussed topics included predicting expansion costs and enrollment, the impact of early expansion on the 2014 roll-out under the ACA, the relationship between expanded coverage and pre-existing insurance programs, and the use of behavioral health and substance abuse services in the expansion population.

The study also identified the following seven key “lessons” for 2014 based on the early expander states’ experiences:

  • Medicaid expansions are generally occurring in states with pre-existing health programs for low-income individuals.
  • Making accurate enrollment and cost predictions for 2014 and beyond will be challenging.
  • Despite expansion, barriers to coverage and access remain.
  • Behavioral health is a “critical need” for the expansion population.
  • Even though the six states made significant investments and efforts to expand Medicaid, they will still face significant implementation challenges in 2014.
  • While officials did not observe significant numbers of previously eligible Medicaid beneficiaries “coming out of the woodwork” to sign up for coverage, it would be premature to rule out this effect, even in states that do not elect to expand coverage.
  • Each state’s political environment will impact the effectiveness of Medicaid expansion.

The authors also pointed out that the six expander states differed in certain important respects from other states.  For example, each of the six states elected to expand Medicaid coverage subject to the state’s traditional baseline federal match rate—that is, they did not receive the initial 100% federal funding under the ACA.  The willingness to expand, the authors assert, reflects a “supportive political environment” in the six states.  Despite this difference, however, the authors noted that the experiences of these states “have broad implications” for the states that plan to expand Medicaid coverage in 2014 or are considering whether to do so.

The study, which is published in the journal Medicare & Medicaid Research Review, is available here.