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|Get Your Mouth Off His Schwantz; entered at 2019-07-27 11:58:22
The States have only one "out" from the program formally and that's to rescind it ENTIRELY. The USSC has already affirmed they can do that when the "expansion" was challenged and ruled unconstitutional. But what the states can't do is pick and choose other than at a legislative boundary.
That is, a non-expansion state can walk off but if it does ALL medicaid funding in that state disappears. An expansion state can revoke its expansion status but that throws ALL of their currently expansion-insured people off instantly. What the state CAN'T do is take the federal funds and then not match on the program rules.
Exactly how bad that gets on a state level depends on the state. But it's the reason that most states which did not do the expansion refused; they knew damn well this was coming. The Feds picked up the first few years of expansion funding but the obligation would be permanent and they knew this, and that trying to rescind it later would likely result in their state capitol being burned to the ground by the angry zero-income people who just got it up the ass. So they said "no."
The problem with this blow-up is that even if a state didn't take the expansion they're still exposed. Not as badly as one that did, but it's still going to be bad in large part because of the nursing home exposure which can be utterly ridiculous and, of course, that's all last-few-years-of-life Seniors. There's already a problem there in that the states try to squeeze providers and pricing to keep from blowing up their budgets to start with; this will get intractable instantly post 2024.