Paying for Medicaid — State Budgets and the Case for Expansion in the Time of Coronavirus

Medicaid — and how to pay for it — has become a recurring theme in several current critical policy debates. Fourteen U.S. states have not yet expanded the program under the Affordable Care Act (ACA), mostly because of concerns about the potential impacts on state budgets, and these decisions have left more than 2 million low-income adults without any health care coverage.1,2 Meanwhile, earlier this year, the Trump administration invited states to submit proposals to shift Medicaid to a block-grant or per-capita-allotment system with a capped federal contribution. Most recently, the coronavirus epidemic has hit like a thunderbolt, both federal and state policymakers are looking to Medicaid as a central tool in their response to this national emergency.

New England Journal of Medicine