All of the congressional health reform proposals expand Medicaid to cover more parents and childless adults. Currently, it is difficult for parents to obtain Medicaid and most childless adults are excluded from the program no matter how impoverished.
After reform everyone under a certain income threshold, likely 133 percent of poverty ($14,400 for an individual), will qualify for Medicaid.
States are worried that the additional cost of new enrollees will place an undue burden on their budgets because Medicaid is a matching program where the states contribute a sizable chunk of the funding.
In different reform bills states are required to pay different amounts. In some of the proposals the federal government would pay the entire cost of the Medicaid expansion and then examine changes to the long-term matching rate.
The Georgetown University Center for Children and Families has some helpful charts  to examine how much North Carolina would pay if the Senate Finance Committee bill prevails.
According to the Senate Finance Committee chart North Carolina would have 448,555 newly eligible and newly enrolled adults. Our state spends about $3,133 per adult in Medicaid so the expansion would cost about $1.4 billion. The Senate Finance Committee proposes covering 95 percent of the cost for the newly eligible, which would leave North Carolina with a bill of $70 million.
That’s a small increase in Medicaid spending to expand coverage to more than 400,000. Obviously it would be nice if the feds would foot more of the bill. But Georgetown argues that even under the Senate Finance Committee plan states are getting a pretty good deal. I agree.