States that did not expand Medicaid under the Affordable Care Act only permit childless adults who make 133% or less of FPL to qualify. This prevents many working poor families from accessing health insurance despite potentially qualifying for marketplace subsidies.
Before the ACA was passed, most low-income states determined Medicaid eligibility based on income minus certain disallowances.
Arizona
Prior to the Affordable Care Act (ACA), most states limited eligibility for childless adults living alone to those whose income fell within each state’s poverty level; however, Arizona, Maine, and New York each offered Medicaid waiver programs which offered coverage up to 100% of federal poverty level for childless adults without dependents.
These programs increased enrollment of childless adults into Medicaid. Furthermore, they helped bridge the gap between current Medicaid eligibility and marketplace subsidies to purchase private health coverage.
The Affordable Care Act mandates states to expand Medicaid eligibility to non-disabled working-age childless adults with incomes up to 138% of FPL who don’t require child care benefits, without raising taxes or cutting spending elsewhere in order to cover millions more people without raising taxes or decreasing other forms of spending. While expanding Medicaid can increase coverage without raising taxes or cutting spending elsewhere, states may have to make tradeoffs between expanding it and maintaining other program funding levels in the long term.
Maine
Prior to the ACA, Medicaid eligibility for childless adults was determined by individual states based on income thresholds that often exceeded federal poverty level. Under this new program, eligibility could now cover childless adults up to 138 percent of federal poverty line.
Prior to the Affordable Care Act (ACA), many working poor families in Maine struggled to afford health insurance. Marketplace subsidies offer assistance for working poor families looking for private coverage through an exchange, including “covering gaps” between what Medicaid pays them and the costs for marketplace plans purchased on it.
Voters approved in November a ballot initiative that will expand Medicaid coverage to cover children and adult workers earning up to 138 percent of federal poverty levels, such as those earning $12,700 annually in Maine. Seema Verma of Centers for Medicare and Medicaid Services has highlighted how expansion will provide coverage gains to these workers and their families.
New York
Prior to the Affordable Care Act, most low-income parents and childless adults in New York had access to Medicaid coverage. After that law took effect, New York expanded Medicaid access up to 100% of federal poverty level (FPL), through its Family Health Plus program – authorized through an 1115 waiver.
As a result of the Supreme Court decision, New York no longer receives enhanced federal matching dollars for this population group; however, due to expanded eligibility under ACA they will still cover this population and benefit from health insurance marketplace subsidies that make private health coverage affordable.
Though some states have elected not to expand their Medicaid programs, all 50 offer some form of the coverage. Programs vary greatly in eligibility requirements and cost-sharing protections; as a result, in 2014 adults in states which did not expand Medicaid reported experiencing financial difficulty in paying medical bills and repaying medical debt at much higher rates than those living in states which expanded their programs.
Texas
Before the Affordable Care Act was implemented, states could set their Medicaid eligibility levels below the federal poverty level, leaving millions of lower-income parents and childless adults unprotected by coverage.
The Affordable Care Act’s Medicaid expansion has changed that. States that adopted it allow parents and childless adults to qualify for Medicaid if their income falls at or below 133% of FPL; federal funding will cover 100% of each state’s cost up to 2016.
However, 16 states still haven’t made this change to their Medicaid programs, leaving about 20 million low-income adults stuck in what’s known as the “coverage gap.” They don’t earn enough subsidies to purchase private health coverage through marketplaces and don’t meet income thresholds for non-expansion Medicaid in their state; creating a major barrier to receiving necessary healthcare services. Expanding Medicaid can increase access, reduce out-of-pocket costs and enhance health outcomes – the benefits being numerous!
