A report from the Kaiser Family Foundation says that some states should see a substantial benefit under the Medicaid expansion provisions of the Patient Protection and Affordable Care Act (PPACA) especially when compared to other states.

The PPACA expands Medicaid to nearly all individuals under age 65 with incomes up to 133 percent of the federal poverty line (FPL) which will extend coverage to large numbers of the nation’s uninsured population, especially adults. However, the ultimate reach of the program will depend heavily on both federal and state actions to implement the new law.

The study, entitled “Medicaid Coverage and Spending in Health Reform: National and State‐by‐State Results for Adults at or Below 133% FPL,” finds that increases in Medicaid enrollment could exceed the 6 million new enrollees estimated by the Congressional Budget Office (CBO).

The KFF report finds that as many as 23 million Americans could be newly enrolled under the Medicaid provisions of the PPACA.

“Today there is a great deal of variation across states in terms of Medicaid coverage, the uninsured, state fiscal capacity, leadership and priorities,” the report states. “These variations make it impossible to know how each state individually will respond to the new health reform law.”

Some states, particularly those in the Northeast and Midwest U.S., currently extend Medicaid coverage to adults with incomes above the threshold set by the PPACA.

Other states, however, offer Medicaid benefits to relatively few adults or those with incomes far below 100% FPL, with Texas having one of the lowest ceilings at 26% FPL. Those states will see the greatest return, with the federal government paying for most of the Medicaid expansion in the first five years. 

But benefit to an individual state is not based solely on their current Medicaid qualification limits. The amount of federal funding that flows to a state is also dependent on the level of outreach.

 “Some states may not aggressively implement health reform and therefore not see significant reductions in the uninsured while other states will have higher levels of participation because of effective outreach and enrollment strategies and see greater reductions in the number of uninsured,” the report says.

Even with the enhanced federal funding, many states that are under budget pressure are decrying the added burden of larger Medicaid roles, saying that administration and outreach costs will burden states further.