With just months remaining before the Jan. 1 rollout of changes to the  Medicaid program that will expand health care coverage to as many as 10-20 million Americans, substantial implementation challenges remain — namely, uncertainty regarding costs and the number of states willing to accept the federal subsidy to expand Medicaid coverage to their citizens.

Benjamin Sommers, assistant professor of health policy and economics at Harvard School of Public Health (HSPH), provided an overview of the latest policy debates and research findings regarding the Medicaid expansion on July 16, part of HSPH’s summertime Hot Topics lecture series.

Implementing the Medicaid expansion “is not going to be smooth sailing,” Sommers said. But, he added, the expanded access for many low-income Americans is “a big step forward in a country that has a long history of health inequity.”

Sommers worked on the law as a senior adviser in the Office of the Assistant Secretary for Planning and Evaluation, in the U.S. Department of Health and Human Services, from 2011-2012.

Under current guidelines, only low-income people in certain categories including children, the elderly, and the disabled are eligible for Medicaid benefits. But the expansion passed as part of the Affordable Care Act (ACA) in 2010 extends eligibility to everyone with family incomes below 133% of the poverty line (approximately $15,000 for a single adult and $30,000 for a family of four). The federal government will pay states 100 percent of new Medicaid recipients’ tabs during the first three years of the Medicaid expansion and 90 percent of those costs in the long run.

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