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# States choosing not to expand Medicaid stand to lose billions, study concludes

BMJ 2013; 347 (Published 06 December 2013) Cite this as: BMJ 2013;347:f7360
1. Michael McCarthy
1. 1Seattle

US states that decide not to take advantage of the Affordable Care Act’s Medicaid expansion program stand to lose billions in federal funding, while their taxpayers subsidize expansion programs in the states that do, a new study says.1

Under the act, states were mandated to expand their Medicaid programs to cover all documented residents under 65 years of age whose income was below 138% of the federal poverty level, about $15 856 (£9700; €11 600) for an individual and$32 499 for a family of four.

The expansion was a key element of the health reform law and was expected to provide health insurance to as many as 21.3 million Americans by 2022. The federal government was to pay most of the cost of …

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