Partial Medicaid Expansion Would Increase Federal Costs

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It would be better if partial Medicaid expansion were pursued as a legislative change rather than an allowable state waiver because, in legislation, Congress could offset the added federal expense with cost-reducing reforms. Among other things, Congress could cut costs by limiting the use of tax schemes intended to circumvent the states' matching payment requirements.
The Supreme Court’s decision in 2012 disrupted the plan to establish a national standard of Medicaid eligibility. The result is vastly different Medicaid eligibility rules across the country, which probably isn’t sustainable over the long term.
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