Exhibit 3. Key Themes from Interviews with Medicaid Officials in Early Expanding States.

Lesson #1: Many Medicaid expansions are occurring in states with pre-existing state health insurance programs for low-income adults. Lesson #2: Expansion-related predictions are challenging. Lesson #3: Barriers to coverage and access remain, even after expanding eligibility. Lesson #4: Behavioral health is a critical need for this population. Lesson #5: While the early expansion required significant administrative efforts to implement, these Medicaid programs— like those in all states—still face major implementation challenges for 2014. Lesson #6: The so-called “woodwork effect” (this is when uninsured individuals who were previously eligible for Medicaid before the ACA “come out of the woodwork” and sign up for coverage) was not apparent in these early expansions, but it would be premature to rule it out even in states that choose not to expand. Lesson #7: Political context matters a great deal in implementing a Medicaid expansion.

SOURCE: Authors’ analysis of interviews with state Medicaid officials.