While coverage and access to Medicaid and the Affordable Care Act’s (ACA) individual marketplaces are rooted in federal law, both programs are also shaped by policy choices at the state level. These decisions can be influenced by state demographics, budgets, and ideologies or politics. The resulting laws and guidance can greatly affect whether older adults or people with disabilities have access to the care they need to live healthy, independent lives.

The Kaiser Family Foundation (KFF), a national nonprofit that analyzes health policy, put together three valuable resources that lay out some of the decisions states have made regarding Medicaid and the ACA, and what effect some of those decisions have had on care.

• In Election 2020: State Health Care Snapshots, KFF compiled demographic and health coverage statistics for each state, including at what income levels the state has chosen to set eligibility for Medicaid.
• In Key State Policy Choices About Medicaid Home and Community-Based Services, KFF shows the significant variation and flexibility states have when it comes to providing access to care that help older adults and people with disabilities stay in their homes rather than an institution.
• In Medicaid Home and Community-Based Services Enrollment and Spending, KFF reveals the effect of those choices and what impact they have on state budgets and the people who need care. For example, states may restrict how many people can receive home-based services, which might force others onto waiting lists or into nursing facilities.

Each of these resources is exceptionally valuable as we move closer to the 2020 election and candidates establish health care positions. The choices states make are vitally important to how their residents access care, even when the program they are administering is a federal-state partnership, like Medicaid. By comparing state choices and the resulting impacts, we can better determine which policy options are truly beneficial to the people who rely on the health care and coverage these programs provide.