In 2012, the U.S. Supreme Court upheld the Affordable Care Act (ACA), which expands access to health care for almost 30 million Americans and strengthens existing protections for consumers in the health insurance market. Among the provisions in the decision is the expansion of the Medicaid program by 16 million recipients. By 2014, states must cover all individuals under age 65 with incomes of less than 133% of the federal poverty line. Because Medicaid is state and federally funded, the Supreme Court ruled that states cannot be forced to participate in the new program and the federal government cannot take away existing Medicaid funding. States must decide whether to participate; as an incentive, federal funding for the expansion is 100% in the initial phase (beginning in January 2014) and decreases to 90% in later years.
- Although more individuals may be covered by Medicaid, audiology and speech-language pathology services are still optional for adults per the decision of the state.
- Reimbursement to providers who participate in the Medicaid program may be inadequate.
- Considerable paperwork may be needed as part of Medicaid participation.
- Medicaid plans for the newly enrolled will need to include the 10 categories of essential health benefits that are also included in the plans offered as part of the health insurance exchanges. Of particular interest for audiologists and speech-language pathologists are habilitation and rehabilitation services and devices.
- State legislatures continue to make decisions about Medicaid expansion that may result in opportunities to provide services to more individuals within the parameters defined as part of the covered services. This is best accomplished by checking with the state Medicaid office.
- As requirements for improvement in computerization and accessibility exist for all Medicaid beneficiaries, more states may choose to participate in the expansion program.
ASHA continues to follow decisions in the states regarding expansion, as more states have decided to participate in the program. For additional information, see ASHA’s issue brief, Preserve Medicaid Coverage of Speech-Language Pathology and Audiology Services [PDF].