Medicaid is a government-run program that offers medical coverage to low-income Americans. It forms the backbone of the Affordable Care Act.
Under the Affordable Care Act (ACA), Medicaid was extended eligibility to low-income adults and their children with incomes below 138% of the federal poverty level (FPL). It also increased subsidy eligibility for private insurance purchased through health exchanges.
Eligibility
In most states, Medicaid offers free or low-cost health coverage based on your income and family size. Coverage is available to children and parents, pregnant women, elderly people with certain income levels, as well as individuals with disabilities.
In the past, eligibility for Medicaid was closely tied to receipt of cash payments under the Aid to Families with Dependent Children program and Supplemental Security Income (SSI). However, with passage of the Affordable Care Act in 2010, income relative to Federal Poverty Level (FPL) became an independent factor in determining adult Medicaid eligibility.
Many adults who become ineligible for Medicare due to income exceeding the resource limits can still qualify for Medicaid by “spending down” the difference between their earnings and the state’s medically needy income standard. This amount is based on expenses for medical and remedial care that they don’t have any other health coverage.
Some individuals may qualify for coverage through the Public Employees Health Benefits Program or Patient Empowerment Program. These programs serve as a last resort option for patients without other insurance options.
Coverage
The Medicaid and Affordable Care Act (ACA) revolutionized how health care is delivered in America. It expanded Medicaid coverage, created a health insurance marketplace, and forbade insurers from denying coverage to people with pre-existing conditions.
To help with costs, the Affordable Care Act introduced premium tax credits and cost-sharing reductions. These changes were intended to make coverage more accessible for lower income individuals and families.
For instance, the Affordable Care Act (ACA) required insurers to cover a list of essential health benefits. This includes 10 categories of healthcare services commonly provided and billed by medical providers.
The Affordable Care Act (ACA) also provided health coverage options to more low-income individuals through the establishment of state or multi-state insurance exchanges. These online platforms help individuals and small businesses locate plans that suit their requirements, with affordable bronze and silver plans that include in-patient/out-patient services as well as prescription drug benefits.
Taxes
The Affordable Care Act offers tax benefits to individuals with health coverage through either an employer or government-sponsored plan. These include an exclusion on the value of employer-provided health insurance for adult children until their 26th taxable year, as well as exclusions on employer contributions to qualified health plans.
Individuals may deduct the cost of employer-provided health coverage that they have from their income through their 26th taxable year if it is part of a cafeteria plan. Employers have until 2010 to amend their plan documents to take advantage of this new benefit.
The Affordable Care Act (ACA) has three objectives: reform the private insurance market-especially for individuals and small groups-, expand Medicaid to working poor families with income up to 133% of the federal poverty level, and transform how medical decisions are made. Each reform relies heavily on people being able to make informed choices.
Expansion
The Affordable Care Act’s Medicaid expansion has significantly expanded eligibility for low-income adults, increasing access to health care and relieving millions of Americans of financial strain due to medical bills.
Although Medicaid provides insurance to many more people than private plans do, the program itself is not perfect. For instance, reimbursement rates for Medicaid plans tend to be lower than private plans’, fewer services are covered, and some providers aren’t accepted at all.
Despite these limitations, evidence from prior state-level insurance expansions suggests that expansion is associated with improved self-reported health outcomes, increased access to preventive and primary care services, and reduced financial strain. Furthermore, expansion has been linked to improved outcomes among individuals with pulmonary, sleep disorders, and critical illness.
