# How does the federal government's financial support of medicaid under the ACA work

**URL:** <https://boards.straightdope.com/t/how-does-the-federal-governments-financial-support-of-medicaid-under-the-aca-work/727987>\
**Category:** Factual Questions\
**Created:** [August 16, 2015, 1:09pm UTC](https://boards.straightdope.com/t/how-does-the-federal-governments-financial-support-of-medicaid-under-the-aca-work/727987 "2015-08-16T13:09:27Z")\
**Posts on this page:** 3\
**Page:** 1

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**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\
**Post date:** [August 16, 2015, 1:09pm UTC](https://boards.straightdope.com/t/how-does-the-federal-governments-financial-support-of-medicaid-under-the-aca-work/727987/1 "2015-08-16T13:09:27Z")

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I’m under the impression that under ACA regarding the expansion of medicaid, the federal government pays 90-100% of the cost of the program.

But is that indefinite, or is that subsidy going to decline over time and the costs be passed onto the states?

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**Author:** ![Honey](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/honey/32/5074_2.png) [@Honey](https://boards.straightdope.com/u/Honey)\
**Post date:** [August 17, 2015, 1:35am UTC](https://boards.straightdope.com/t/how-does-the-federal-governments-financial-support-of-medicaid-under-the-aca-work/727987/2 "2015-08-17T01:35:10Z")

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According to [this](http://familiesusa.org/product/50-state-look-medicaid-expansion)site, 2020 and beyond the government will pay 90% of the cost. As of now, there are still 19 states that have not expanded Medicaid.

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**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\
**Post date:** [August 17, 2015, 5:03pm UTC](https://boards.straightdope.com/t/how-does-the-federal-governments-financial-support-of-medicaid-under-the-aca-work/727987/3 "2015-08-17T17:03:35Z")

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The federal government continues to pay a portion of Medicaid costs for those persons who were eligible for Medicaid per-PPACA. The federal contribution varies by state according to a rather incomprehensible formula. For those persons the federal contribution is roughly 75-80% of the total premium. The states pick up the rest.

With the PPACA the federal government demanded that states expand the pool of eligible persons for Medicaid coverage with the federal government picking up 100% of the premium only for those newly eligible and only until 2016.

[Kaiser Family Foundation notes](http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/):

> [@](#):
>
> …states will receive 100% federal funding for 2014 through 2016, 95% federal financing in 2017, 94% federal financing in 2018, 93% federal financing in 2019, and 90% federal financing for 2020 and subsequent years.

Of course the Medicaid expansion requirement was ruled unconstitutional by the Supreme Court and many states chose not to expand Medicaid. In those states the federal government continues to provide a federal contribution at previous rates to those previously eligible for Medicaid coverage.