"The ability to opt out is certainly better than no option," Salo says, adding that "some states have been reluctant because "they had felt trapped by the permanency of it. But I don't think that in and of itself is enough to say that states will feel better about adopting the Medicaid expansion."
Too many other questions about how the Medicaid expansion would work need to be answered soon, says Salo, whose organization last month sent a list of 47 questions about the protocols for the expansion programs to CMS.
Questions about the Medicaid expansion provisions of the Affordable Care Act emerged June 28 after the U.S. Supreme Court ruled on a provision of the law that said if states did not expand their Medicaid programs to 138% of the federal poverty level, the point at which subsidies for the federal exchanges would kick in, would not lose all their federal Medicaid funding match, which ranges around 50%. The court declared that invalid, saying that states could opt out of the expansion to 138% without losing all their funding.
Some 30 states, including many that challenged the constitutionality of the Patient Protection and Affordable Care Act, such as Texas and Florida, have said they don't intend to expand, while others are await further clarifications before announcing their decisions.