NEW YORK--(BUSINESS WIRE)--
HMS, Inc., a wholly-owned subsidiary of HMS Holdings Corp. (NASDAQ:
HMSY), today released its comments on what the Supreme Court Decision on
the Affordable Care Act (ACA) means for States.
On June 28, 2012, the Supreme Court upheld the Affordable Care Act and
most of the law’s provisions as constitutional. The long-awaited
decision resolved many issues, but created several more — especially for
states that now need to move forward.
What does the decision mean for states?
Answering that question requires revisiting the Act. Upheld provisions
include the individual mandate, implementation of state health insurance
exchanges, and such program integrity requirements as Medicaid Recovery
Audit Contracts — the vehicle for states to contract with a vendor in
order to identify and to recover improper Medicaid payments.
Though the Medicaid expansion provision of the Act was found to be
constitutional, the Court ruled that the federal government could not
withhold funding for existing Medicaid populations if a state elected
not to expand its Medicaid qualification requirements to 133% of the
Federal Poverty Level (FPL). The ruling also created a potential gap in
subsidies between Medicaid and state health exchanges. In a no-expansion
state with an income threshold for Medicaid eligibility that falls below
100% of the FPL, people who don’t qualify for Medicaid but fall short of
100% of the FPL — typically adults with no dependents — would not be
eligible for federal subsidies in the exchange. In an expansion state,
there would be seamless integration of subsidies between Medicaid and
In short, states can choose to expand their Medicaid populations as per
the Affordable Care Act guidelines or not. Now states must weigh the
arguments for and against the expansion of their Medicaid populations.
On the pro side, Medicaid expansion would mean many of the state’s most
needy uninsured would have health insurance coverage paid for almost
exclusively by the federal government from 2014 to 2016. Supporters
argue this would result in better care, close the subsidy gap outlined
above, and reduce uncompensated expenses that are currently borne by
states and providers.
On the con side, Medicaid expansion would be funded completely by the
federal government only through 2016. In 2017, federal funding for new
Medicaid members would fall to 95%, phasing down to 90% in 2020 and
beyond. Opponents note that states — already under pressure from a weak
economy — would be required to step up spending as the feds step back.
Finally, expanding Medicaid is not a one-time decision for states. In
theory, states could expand and receive the extra federal funding until
2016, and then contract if this funding changes. Service roll-backs may
For more information on how the Supreme Court’s decision on the
Affordable Care Act affects states, contact firstname.lastname@example.org.
HMS is the nation's leader in coordination of benefits and program
integrity services for healthcare payers. HMS's clients include health
and human services programs in more than 40 states; commercial programs,
including commercial plans, employers, and over 120 Medicaid managed
care plans; the Centers for Medicare and Medicaid Services (CMS); and
Veterans Administration facilities. As a result of the company's
services, clients recovered over $2 billion in 2011, and saved nearly $7
billion through the prevention of erroneous payments.
HMS, Inc.Media RelationsFrancesca Marraro, email@example.com
Source: HMS, Inc.