Medicaid Expands in Some States While 5 Million Remain Uninsured

As of April 1, 2014, Medicaid eligibility has gone up in the majority of states while trends in other states have left millions uninsured, according to a Kaiser Foundation analysis. The report, which analyzed CMS data and Medicaid and CHIP eligibility standards, found that the Patient Protection and Affordable Care Act’s (ACA) (P.L. 111-148) Medicaid expansion has had an overall positive impact on nationwide eligibility levels. However, despite increases in Medicaid eligibility across several categories for adults and children, about 5 million adults remain uninsured, victim to a coverage gap created by their state’s non-expansion. The report identifies a sharp distinction between those states increasing coverage through expansion and those states that have limited eligibility by choosing not to adopt Medicaid expansion.

Expansion

The ACA, as it was enacted, required states to expand Medicaid eligibility to 138 percent of the Federal Poverty level (FPL). Due to a Supreme Court ruling on the constitutionality of the expansion mandate, the decision to expand became a state option. According to a Kaiser Foundation summary, 26 states and the District of Columbia have made the decision to expand. There is no deadline by which a decision to expand must be made and several states have reported that they are still considering expansion.

Children

The report indicates that Medicaid and CHIP coverage remains strong across the states. More than half the states have Medicaid and CHIP eligibility for children in families with incomes at 250 percent of the FPL.

Pregnant Women

Many states that covered women in Medicaid to at least 133 percent of the FPL prior to the ACA’s enactment are continuing to do so. The report indicates that 30 states have Medicaid eligibility for pregnant women that reaches 200 percent of the FPL. However, the ACA’s mandate to keep eligibility levels for women above the 133 percent threshold expired on January 1, 2014. Since the expiration of that ACA requirement, three states (Louisiana, Oklahoma, and Virginia) have reduced their eligibility levels for pregnant women.

Only Some

The report indicates that the 26 states and the District of Columbia) that have expanded Medicaid have seen dramatic increases in Medicaid coverage and eligibility. However, for the 24 states that have not, eligibility levels are low or non-existent. In 20 of those states, eligibility levels for parents are below the FPL and, in 12 states, the eligibility is below half of the poverty line. In some states, childless adults are not eligible at all. Of the parents and children whose incomes fall above restrictive eligibility standards, many have incomes that fall below the level required to earn a premium tax credit for new Marketplace coverage. Those in the coverage gap number at about 5 million.