Excluding people already in the Medicaid program for the poor may penalize a population more prone to chronic conditions, researchers from George Washington University said in an article published today in the journal Health Affairs. The 2010 Affordable Care Act guaranteed preventative screenings to almost all who enroll in the expanded version of Medicaid and states were given the option of whether to offer those services to people already in the program.

While the law provides some money to avoid such disparity, the federal incentives may be insufficient to change the minds of governors and legislators. Some states, including Virginia, Utah, Montana and Vermont, have decided it’s not worth the financial burden, said Sara Wilensky, a faculty member at George Washington University’s Department of Health Policy.

“Certainly a lot of poor people are going to be left out from these preventive services,” Wilensky, the lead author of the report, said in a telephone interview.