Medicaid Expansion

Medicaid expansion is a major provision of ObamaCare, allowing more low-income Americans to obtain coverage. While it is not mandatory or implemented in each state, the states that have decided to broaden the income threshold for Medicaid enrollment help connect their needy population to coverage. Medicaid is the free health insurance program for poverty-level families and individuals, which has for the most part favored children, pregnant women and the disabled. Some adults could apply prior to this provision of the Affordable Care Act, but only if they were about to have children, had children already, or had a disability. Medicare beneficiaries with low income are also eligible, yet the program excluded a significant piece of the low-income population: childless adults between ages 19 and 64.

Under the ACA, states could choose to increase income guidelines up to 133 percent of federal poverty for adults with or without children. Above that income level, you can apply for heavily subsidized coverage on the exchange. In a nation full of financial hardship, Medicaid expansion is a timely solution for the poor and uninsured.

Each state that approved Medicaid expansion passed statewide legislature permitting childless adults to apply for coverage with income up to 133 percent of poverty. The federal government provided those states with several billion dollars in funding to accommodate the newly eligible beneficiaries and program costs for the first few years of expansion. The government pays the entire estimated cost of expansion for the first three years, from 2014 through 2016, and tapers off to 90 percent by 2020.

Most states chose to implement Medicaid expansion in 2014, while others got an early start beginning in April 2010. For adults with or without children, expanding Medicaid brings a great opportunity to gain coverage. While some parents qualified for public coverage before the health care law, the income limits were set very low, so that in many households, a child could get covered under Medicaid but their parents were ineligible. As most Medicaid programs enroll children with income of at least poverty-level or greater, it is now fair that their parents can also receive free or low-cost coverage.


Medicaid Expansion in the States

Reluctant to turn down federal funds, many states that initially opposed the expansion built on the idea of insuring more poor people and created their own approach, such as Healthy PA in Pennsylvania and the waiver program in Iowa. Approved by the Centers for Medicare and Medicaid Services, these plans are considered a form of Medicaid expansion, although they may have small payments involved, such as a low monthly premium and modest cost-sharing. Twenty-two states declared they would not expand by 2014, though there is no deadline to do so and any state can decide to expand later. As mentioned, the benefit of the states who modified their Medicaid programs under health reform in 2014 is larger funding for a longer period of time.


Arizona New Hampshire Alabama
Arkansas Ohio Alaska
California Tennessee Florida
Colorado Georgia
Connecticut Idaho
Delaware Indiana
District of Columbia Kansas
Hawaii Louisiana
Illinois Maine
Iowa Mississippi
Kentucky Missouri
Maryland Montana
Massachusetts Nebraska
Michigan North Carolina
Minnesota Oklahoma
Nevada South Carolina
New Jersey South Dakota
New Mexico Texas
New York Utah
North Dakota Virginia
Oregon Wisconsin
Pennsylvania Wyoming
Rhode Island
West Virginia


Eligibility Limits

According to the final rule on Medicaid eligibility under the ACA issued by the CMS in March 2012, all individuals between ages 19 and 64 who earn up to 133 percent of the federal poverty guideline, which was $15,282 per year for one person and $31,322 for a family of four in 2013, will qualify for coverage. Unfortunately, it only applies in states where Medicaid has expanded, leaving many Americans uninsured and unable to afford a health plan on the exchange. In states where no Medicaid expansion has occurred, exchanges will issue subsidies beginning at 100 percent of federal poverty, however.

Compared to the past, income guidelines have increased for nearly every eligibility group if they weren’t at least 133 percent of poverty previously. In many states, children and pregnant women who met those limits could get insured under Medicaid or CHIP — and only temporarily as a pregnant woman. Under expansion, women who earn up to 133 percent of FPL can stay insured even after their maternity benefits under Medicaid expire, which would traditionally be 60 days after childbirth. The newborn would gain coverage through Medicaid, but a mother would have to go uninsured again if not for this law. Now, states where Medicaid has expanded must offer coverage to all adults (working and non-working), children and pregnant women in households who earn at least this amount. It may be higher depending on your state.