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Medicaid Expansion: What It Means for You

Medicaid is a joint federal and state program that provides health insurance to low-income individuals and families. The Affordable Care Act (ACA) expanded Medicaid to cover more people, but not all states have adopted this expansion. This article will explain Medicaid expansion, its implications, and how to determine whether you qualify in your state.

What is Medicaid Expansion?

Medicaid expansion was a key provision of the Affordable Care Act, aimed at broadening eligibility for Medicaid. Before the ACA, Medicaid eligibility was primarily limited to low-income families, pregnant women, children, elderly adults, and people with disabilities. The expansion extended Medicaid to include low-income adults who earn up to 138% of the federal poverty level (FPL).

Who Benefits from Medicaid Expansion?

  1. Low-Income Adults: Medicaid expansion covers adults between the ages of 19 and 64 with incomes up to 138% of the FPL. This includes individuals without children or disabilities, who were not traditionally eligible for Medicaid.
  2. Dual-Eligible Individuals: Those eligible for both Medicaid and Medicare may benefit from expanded Medicaid services, reducing costs for Medicare premiums and providing additional services such as long-term care.
  3. States That Expanded Medicaid: As of 2024, 40 states and Washington, D.C. have expanded Medicaid, offering broader coverage for residents.

States That Have Not Expanded Medicaid

There are still 10 states that have not adopted Medicaid expansion. In these states, the eligibility criteria remain more restrictive, and low-income adults without dependent children or disabilities may not qualify for Medicaid. This has created a coverage gap for individuals whose income is too high for traditional Medicaid but too low to qualify for subsidies on the Health Insurance Marketplace.

Implications of Medicaid Expansion

  1. Improved Access to Care: In states that have expanded Medicaid, millions of low-income adults have gained access to essential health services, including preventive care, hospital stays, mental health treatment, and prescription drug coverage.
  2. Financial Protection: Medicaid expansion reduces out-of-pocket medical expenses for enrollees. For those who qualify, it eliminates the need to purchase private health insurance or pay high deductibles.
  3. Reduction in Uncompensated Care: Hospitals and healthcare providers in Medicaid expansion states have seen a reduction in uncompensated care, improving overall healthcare infrastructure.
  4. Impact on Dual-Eligible Individuals: Those who qualify for both Medicaid and Medicare (“dual-eligibles”) benefit from Medicaid expansion, as Medicaid helps cover Medicare premiums, co-pays, and services like long-term care, which are not fully covered by Medicare.

How to Check Eligibility in Your State

If you live in a state that has expanded Medicaid, you may qualify for coverage if your income is below 138% of the federal poverty level (FPL). As of 2024, the income limits for Medicaid expansion are approximately:

  • $20,120 for an individual.
  • $41,400 for a family of four.

You can check your eligibility and apply for Medicaid through your state’s Medicaid website or the federal Health Insurance Marketplace at Healthcare.gov.

What to Do If Your State Hasn’t Expanded Medicaid

If you live in a state that has not expanded Medicaid, your options for health insurance may be limited if your income is too low to qualify for subsidies on the Marketplace. In this case:

  1. Check State-Specific Programs: Some states have alternative programs or Medicaid waivers to cover certain low-income populations. Check your state’s Medicaid website for more information.
  2. Health Insurance Marketplace: If your income is above the Medicaid eligibility threshold but below 400% of the FPL, you may qualify for subsidies or premium tax credits on the Marketplace to reduce the cost of private health insurance.

Medicaid Expansion and Dual Eligibility

For those eligible for both Medicare and Medicaid, Medicaid expansion provides additional support that Medicare does not. Expanded Medicaid benefits help cover:

  • Medicare Part B premiums.
  • Co-pays, deductibles, and coinsurance for Medicare-covered services.
  • Long-term care services, such as nursing home care or in-home support, which Medicare does not typically cover.

If you are dual-eligible and live in a Medicaid expansion state, it’s important to review both your Medicare and Medicaid benefits annually to ensure you’re getting the most comprehensive coverage at the lowest cost.