To understand Medicaid expansion, we have to go back to the days before 1965 when Medicaid was introduced. Until then, the care of older adults, the terminally ill, people with chronic illnesses, and those who could not afford health insurance was in the hands of families, friends, or charities. The introduction of Medicaid in 1965 (Social Security Amendments) committed the federal government to give matching funds to states to help them provide support for residents without the income or resources to pay directly for treatment or the cost of commercial health insurance plans. Each state remained free to decide what services to provide or support and the qualifying criteria, e.g., age, illness, or disability.
The consequence of this freedom was that many states set the income eligibility level far below the Federal poverty level, and some states did not let non-disabled adults participate in Medicaid.
These anomalies were partly removed by the Affordable Care Act (ACA) passed in 2010 (effective 2014), which, among other things, ‘expanded’ the terms of the 1965 (Social Securities Amendments) or, as we know it, Medicaid.
The Federal government intended the Medicare expansion to apply to all U.S. states. However, The Supreme Court decided (2012) that states had the right to continue using their pre-ACA Medicaid eligibility criteria and receive the previously established federal contribution (50%)
If your state has not expanded Medicaid, this is where you come in. You or someone close to you may be affected.
When the Medicaid expansion first came into effect (2014), only 26 states (+DC) accepted the Federal government’s offer to contribute 90% of the program’s cost.
To be eligible for Medicaid, you must meet specific criteria. For example, you must:-
- Be a U.S. citizen (or a qualified non-citizen)
- Be a resident of the state to which you are applying
- Have a low (or very low) income and limited resources
- Belong to a particular category of people, such as:-
- The elderly
- Pregnant women
- Young children
- People with disabilities
To date (September 2023), 41 states (including D.C.) have adopted the Medicaid expansion and the enhanced federal matching rate,i.e., the amount the federal government contributes to each state’s Medicaid program. Although every state operates within broad federal guidelines, Medicaid is administered by the states. Each state’s program is tailored to meet its needs and goals.
The ten states that have not adopted Medicaid expansion may have income eligibility levels lower than prescribed by the ACA (138% of the national poverty level). Some may also exclude individuals with some illnesses or disabilities from participating in their Medicaid program.
Suppose you are a resident of one of these states. In that case, contact your state Medicaid agency to obtain specific details of the state’s program.
Florida
Alabama
Georgia
Kansas
Mississippi
Tennesse
South Carolina
Wisconsin
Wyoming
Texas
You are not alone. In May 2023, there were 74 million people enrolled on Medicaid, of whom around 15% are also registered on Medicare and 11% have private insurance. Neither Medicaid nor Medicare will cover all your costs. Even if you are eligible to enroll in both, there are costs that you must pay ‘out of pocket.’
The Federal Poverty Level (FPL) is $14,580 for an individual ($30,000 for a family of 4.) You are eligible for Medicaid if your income is below $20.120 ( individual) or $41,400 (family of 4). If your income is above these levels (max $58,250 individual and $120,000 family of 4), you are still eligible for help to pay the premium for an ACA-compliant health insurance plan (sometimes, the net premium can be zero.)
Whatever your circumstances, it makes sense to make the most of all the subsidies available to you by talking first to your medical provider and then to a qualified health insurance advisor familiar with your state regulations.
That way, you can find the most affordable plan(s) that meets your needs.
