A new Urban Institute study, funded by the Robert Wood Johnson Foundation, found that hospitals may increase their revenues if states elect to expand Medicaid. Under the Affordable Care Act (ACA), states can opt to expand their Medicaid eligibility to adults with incomes up to 138% of the federal poverty line. In doing so, the study claims that the revenues lost from individuals switching to Medicaid from private insurance, which offers lower reimbursements to providers, will be offset by the large number of individuals who would be receiving coverage as a result of Medicaid expansion. The Urban Institute determined that for each dollar lost from private insurance revenue, hospitals would increase Medicaid revenue by $2.59.

A new report from the Robert Wood Johnson Foundation's State Health Access Data Assistance Center details the number of individuals estimated per state to be excluded from Medicaid coverage after implementation of the Affordable Care Act (ACA). Despite the vast increase in individuals that will gain access to insurance due to the ACA, there remain a large number of non-elderly, low-income adults that will still not be eligible for coverage, even in states that expand Medicaid. The basis for this exclusion is immigration status, as legal permanent residents, under most scenarios, remain ineligible for coverage for the first five years in which they legally reside in the US. Unauthorized immigrants are completely barred from receiving Medicaid.

The Congressional Research Services (CRS) published a memo saying that states cannot change Medicaid eligibility before 2014. The Affordable Care Act (ACA) requires states to maintain 2009 Medicaid eligibility standards through 2014 as part of the maintenance of effort provision. The purpose of this effort is to stop states from limiting eligibility until the federal government reimbursement increases take effect in 2014. The Supreme Court’s June 28th ruling on Medicaid expansion caused many leaders to call into question the ACA's maintenance of effort provision. The CRS report confirms that the ruling does not free governors to modify current Medicaid eligibility rules. The Obama administration has made similar arguments in letters to governors, saying that the Supreme Court ruling only affected Medicaid expansion and did not carry over into other provisions such as maintenance of effort. The CRS report was less clear regarding whether states can choose to expand Medicaid after 2014. The report said that Health and Human Services Secretary Kathleen Sebelius could decide that states must join the expansion by 2014, noting, however that a state could argue that if it meets the health care law’s Medicaid requirements at a later date, the federal government must support them. The report also said that it is unclear if states can choose to cover some, but not all, of the newly eligible group of Medicaid beneficiaries.