States that expand their Medicaid programs under the Affordable Care Act can later decide to not maintain the expansion, according to the Centers for Medicare and Medicaid Services.

That was the message that Cindy Mann, director of the Center for Medicare and CHIP Services in CMS, brought to a summit of the National Conference of State Legislatures in Chicago on Aug. 7, according to the AHANewsNow newsletter. If a state decides to expand Medicaid and does so, and later determines it does not want to maintain the expansion, it can drop the expansion, Mann said.

That’s a new twist on Medicaid expansion that goes even further than steps CMS took in mid-July. CMS then advised states that they could get federal funding to implement information technologies to support Medicaid expansion and health insurance exchanges before they commit on going through with the initiatives, and with no penalties if they don’t.

In upholding most of the Affordable Care Act, the Supreme Court ruled that Medicaid expansion was constitutional, but the feds could not hold back existing Medicaid funding if a state did not expand Medicaid. Since then, CMS has been clarifying provisions of the expansion program in response to questions from state governors and legislators.

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