Medicaid was originally created to serve society’s most vulnerable Americans—pregnant women, children, seniors, and people with disabilities. Obamacare dramatically expanded the program to millions of able-bodied, working-age adults and created powerful incentives for states to maximize expansion enrollment. For every $1 states spend on expansion adults, the federal government contributes roughly $9—far more generous than the federal match for traditional Medicaid populations.
This Paragon PIC shows the share of Medicaid enrollees classified as ACA expansion adults by state. On average, expansion adults account for roughly 30 percent of Medicaid enrollment in expansion states, and they represent more than 40 percent of Medicaid enrollees in several states, including Oregon, Louisiana, and Nevada.
These figures help illustrate how large the Obamacare expansion population has become relative to Medicaid’s traditional populations. In many states, healthy, working-age adults now comprise between one-quarter and one-half of all Medicaid enrollees.
The expansion’s financing structure also creates significant program integrity concerns because states receive a much more generous federal match for expansion adults than for traditional enrollees. As prior Paragon research has shown, some states may have incentives to classify traditional enrollees as expansion adults to secure enhanced federal reimbursement.
Research also suggests that Medicaid expansion has strained access to care for traditional Medicaid enrollees while delivering relatively limited value for taxpayers and beneficiaries. Studies have found that expansion can increase wait times, reduce access to providers, and generate relatively low value relative to program costs.
