Despite the expansion of Medicaid to childless adults under the Affordable Care Act (ACA), millions of low-income, childless adults in non-expansion states remain without coverage.
This brief examines how many adults would have gained Medicaid coverage if their states had adopted the ACA expansion. It also looks into the consequences of not having coverage for them.
Massachusetts
In 2006, Massachusetts implemented a state health reform initiative that provided Medicaid-like coverage to low-income childless adults. This major component of the 2006 law resulted in record rates of insurance coverage and improved access to care for millions of Americans.
The Patient Protection and Affordable Care Act (ACA), passed by Congress in 2010, extends Medicaid eligibility to nearly all nonelderly adults up to 138 percent of the federal poverty level. As such, states that adopt its Medicaid provisions are likely to experience substantial increases in coverage rates as well as improved access for low-income childless adults.
Estimating the effects of health reform on childless adults in Medicaid’s target population can be challenging due to small sample sizes in national surveys and limited information about these groups. Linking state and federal surveys, however, offers a strategy for leveraging state-specific survey data for stronger policy evaluations.
New York
Prior to the Affordable Care Act (ACA), New York State Medicaid program offered coverage to childless adults with incomes up to 100% of the Federal Poverty Level (FPL) through its Family Health Plus program. This group transitioned into adult status under ACA regulations in January 2014.
At the end of 2022, New York had over 7.7 million enrolled in various Medicaid expansion categories and pre-ACA eligibility categories. Most of this population were in managed care programs under an 1115 waiver that has been in place since 1997.
The Affordable Care Act (ACA) expands Medicaid eligibility to childless adults up to 133% of the Federal Poverty Level, providing states that had not previously covered these individuals with enhanced federal funding. Through 2016, the federal government will cover 100 percent of Medicaid costs for these individuals; gradually decreasing to 90 percent in 2020 and thereafter. Furthermore, states receive an additional 6.2% match under Families First Coronavirus Response Act during COVID public health emergency period; this federal funding will gradually phase out over 2023.
New Jersey
New Jersey’s Medicaid program offers healthcare coverage to low-income children, pregnant women, parents, seniors and individuals with disabilities through a federal-state partnership.
Medicaid has provided millions of Americans with health care coverage at lower costs, helping them stay healthy longer. It also helps prevent expensive hospitalizations by financing medication, primary care and outpatient treatment that keeps people healthy.
In 2011, New Jersey began expanding Medicaid coverage to childless adults with incomes up to 23% of poverty. Many of these newly enrolled individuals could lose their coverage if the state repeals this expansion.
Furthermore, if NJ FamilyCare is repealed, over 2.2 million individuals who currently have coverage through the program must be re-determined for eligibility. This process could take an extensive amount of time and result in fewer enrollees than what the state had before Medicaid expansion.
District of Columbia
Since the mid-90s, Washington DC has offered Medicaid coverage to childless adults. However, until 2012 when the US Supreme Court allowed states to expand eligibility, Medicaid only covered those below 133 percent of the poverty level.
In 2014, the Affordable Care Act (ACA) extended Medicaid eligibility for nonelderly parents and adults without children (new adults). This expansion now covers incomes up to 138% of the federal poverty level with an enhanced federal matching rate; 40 states have implemented it while 11 have not.
Medicaid expansion could provide greater health care access and reduced out-of-pocket expenses for low income individuals, leading to improved self-reported health and reduced unhealthy behaviors such as changing one’s eating habits, upping physical activity levels, and quitting smoking altogether.
