Among the many provisions of the Patient Protection and Affordable Care Act (PPACA)designed to expand access to health insurance in the United States, two significant components have engaged public policymakers in the Commonwealth of Virginia: Medicaid expansion and the question of the state operating an insurance exchange.
To improve access to health coverage, section 2001 of the PPACA established a new state option, beginning Jan. 1, 2011, to provide Medicaid coverage to additional individuals in each state through an amendment to its state plan of medical assistance. Eligible individuals include those under age 65, who are not pregnant and not entitled to Medicare. The law created a mandatory Medicaid eligibility category for individuals with income at or below 133 percent of the Federal Poverty Level (FPL) beginning Jan. 1, 2014. Also, the mandatory Medicaid income eligibility level for children ages 6 to 19 changes from 100 percent FPL to 133 percent FPL. States have the option to provide Medicaid coverage to all individuals under the age of 65 and above 133 percent of FPL through a state Medicaid plan amendment. One of the most-discussed features of the PPACA is the federal share of the cost of Medicaid expansion. From 2014 through 2016, the federal government will pay a state with an expanded Medicaid eligibility 100 percent of the cost of covering the new Medicaid recipients. Then these federal Medicaid matching payments decline: 95 percent in 2017, 94 percent in 2018, 93 percent in 2019 and 90 percent thereafter. 

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Reprinted from the Spring 2013 issue of the VBA Journal with permission of The Virginia Bar Association and author Thomas W. Greeson.