Approved Demonstrations Offer Lessons for States Seeking to Expand Medicaid Through Waivers

Twenty-six states and the District of Columbia are now implementing health reform’s Medicaid expansion. Arkansas, Iowa, and Michigan have expanded through federally approved Medicaid demonstration projects, or “waivers.”

As most future state expansions are likely to be implemented through waivers of some kind, the guardrails the federal government has established so far around what is and is not permissible in a Medicaid expansion waiver offer useful lessons for policymakers in states considering whether to expand Medicaid. Future state decisions about the Medicaid expansion will likely be as much about how to expand as about whether to expand.


Medicare Is Not “Bankrupt”

Medicare has grown somewhat stronger financially in both the short and long term but continues to face long-run financing challenges, according to the latest report from the program’s trustees. Claims by some policymakers that the Medicare program is nearing “bankruptcy” are misleading. Although Medicare faces financing challenges, the program is not on the verge of bankruptcy or ceasing to operate.

Related: Statement of Paul Van de Water, Senior Fellow, on the 2013 Medicare Trustees' Report


Health Reform’s Medicaid Expansion Is an Even Better Deal for States

CBO now estimates that the federal government will, on average, pick up more than 95 percent of the total cost of the Medicaid expansion and other health reform-related costs in Medicaid and the Children’s Health Insurance Program (CHIP) over the next ten years (2015-2024).

States will spend only 1.6 percent more on Medicaid and CHIP due to health reform than they would have spent without health reform.




Medicaid is a federal-state public insurance program that provides health coverage to nearly 65 million low-income Americans, including children, parents, seniors, and people with disabilities. The Children’s Health Insurance Program (CHIP) gives states matching federal funds to provide health coverage to nearly 8 million children in families whose income is modestly above Medicaid limits, typically up to 200 percent of the poverty line. Medicare is a federal program that provides health coverage to about 47 million Americans, primarily individuals age 65 and older but also including several million younger adults with permanent disabilities. The Affordable Care Act, the health reform law passed in 2010, will help an estimated 32 million uninsured Americans obtain quality, affordable health coverage in both the private and public markets.

Policy Basics:
- Introduction to Medicaid

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The Center works to ensure that federal and state health insurance programs provide coverage that meets the health care needs of low-income children and families, as well as seniors and people with disabilities.  The Center also works to remove barriers preventing eligible families from gaining access to health coverage.

By the Numbers

Rate of Uninsured Fell Again in 2012
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