Regardless of the decision by individual states to accept or reject the Medicaid expansion called for by the Patient Protection and Affordable Care Act (PPACA), all states have to make changes to their Medicaid enrollment systems in order to be in compliance with the PPACA provisions, which take effect on Jan. 1, 2014.
And, according to the results of a state survey that was conducted by the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families, 47 states have already accepted or requested money from the federal government to do just that.
While at least a dozen Republican governors have publicly expressed a disdain for the PPACA, the fact that 47 states have sought out federal funds for the modernization seems contradictory; but, considering that the Medicaid expansion is only one part of the PPACA, one quickly understands the reason for the modernization does not arise solely from the expansion, but from the new health insurance exchanges that every state will have.
Since all of the states will have exchanges, and it is possible that states that reject the expansion now may opt-in later, upgrading the Medicaid systems now will allow those states to integrate their existing insurance exchanges with their expanded Medicaid programs.
At this point, 42 states have started working to develop their systems so that enrolling will be a much easier process, but, with less than a year to go, there is still quite a bit of work to do.