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Will the Medicaid Expansion “Triggers” Fire?

Updated: Apr 13

MEDICAID EXPANSION: You can check out, but you can never leave.

MEDICAID EXPANSION: You can check out, but can you ever leave?

The House just passed HB1219 which includes funding for Medicaid expansion. You can see how your representative voted here. The Senate is convening now to consider the measure, but before they pass it they should consider a new paper from Advance Arkansas Institute that outlines some of the legal concerns with “opting out” of expansion once we opt-in:

Lawmakers have spent a substantial amount of time this session creating and designing this particular version of Medicaid expansion, which would funnel Medicaid payments through private insurance companies. Legislators who must choose whether to fund Medicaid expansion (whether it is labeled the private option or not) should understand that a central argument made in expansion’s favor is groundlessly overconfident. More precisely, the advocates of the private option version of Medicaid expansion have explained that, if their plan does not work as expected (if, for instance, the federal government fails to make good on its future commitments), then Arkansas can always exit the expansion and return to the previous status quo. Unfortunately, private-option advocates have ignored both statutes and case law when explaining that Arkansas can always check out of the private option if the federal government fails to meet its funding commitments. Advocates of the private option therefore make a fundamental mistake when they explain that Medicaid expansion can risklessly be explored or casually exited; in fact, there is substantial reason to believe that when a state chooses Medicaid expansion, it is something like a decision to go down a one-way street. As one of us recently explained when testifying before the Ohio General Assembly, there is in fact a substantial legal question as to whether a state can exit Medicaid expansion after entering it. Of course, as a literal matter, a state can always end its Medicaid program completely; the question at issue here is whether a state, after expansion, can revert to its pre-expansion status without jeopardizing all Medicaid funds.

To put it simply: the triggers that lawmakers have put into the “private option” bill may not fire, according to federal law that governs the Medicaid program.

Read the full paper, authored by Dan Greenberg of AAI and Robert Alt of the Buckeye Institute, at

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