Yes Virginia, the 90 percent Medicaid match is permanent

Published July 22, 2021

By Peg O’Connell

Recently a colleague was a guest on a radio talk show out in the western part of North Carolina and was challenged by one of the hosts on the permanency of the 90% federal Medicaid match for states that close their health insurance coverage gap. The host would simply not accept the fact that this enhanced match is permanent.  So, in case there are any other Doubting Thomases out there, I thought now would be a good time to address this issue.

Section 1905 of the Social Security Act: , is part of the Affordable Care Act that was passed in in 2010.  This is the provision that increased the federal match for states that expand their Medicaid programs to cover people up to 138% of the poverty level.  These are the folks that are currently in the coverage gap in North Carolina. In relevant part it says, “Federal medical assistance percentage for a State that is one of the 50 States or the District of Columbia, with respect to amounts expended by such State for medical assistance for newly eligible individuals described in subclause (VIII) of section 1902(a)(10)(A)(i), shall be equal to…(E) 90 percent for calendar quarters in 2020 and each year after.” If you don’t believe me, you can click on the link above and see the actual statute.

There is no expiration date on this 90% match, no reauthorization required, no hidden trap doors.  It would take an Act of Congress in order for the match to be enhanced or reduced. Now, I don’t mean to throw stones, but our federal policymakers have tried to monkey with the Affordable Care Act in the past and found themselves on the receiving end of a firestorm.  It is not likely they will try again soon. The ACA is the law of the land and will be for the foreseeable future.  It has withstood legislative challenges and constitutional challenges and is still going strong.   

So, to borrow a phrase, “Yes Virginia,” the 90 percent Medicaid match is permanent and it is time to stop using it as an excuse for failing to find a North Carolina solution to close the coverage gap.   North Carolina is one of only 12 remaining states that have failed to find a viable solution for closing the coverage gap to provide an affordable option for working people to get health insurance. 
The six hundred thousand North Carolinians stuck in the coverage gap need our help. We need to get this done for them.