One of the principal objectives of the health reform legislation was to provide health insurance coverage to those who are presently uninsured. In keeping with that objective, one of the provisions of the Patient Protection and Affordable Care Act is to expand Medicaid coverage by the year 2014. The new nationwide threshold for eligibility for Medicaid will be 133 percent of the federal poverty level, which under current guidelines would be about $14,400 for a single adult and $29,300 for a family of four.
As explained by Cindy Mann, Director of the Center for Medicaid and State Operations, Medicaid coverage is expanded to include persons who did not previously qualify. Under the new rules, you do not have to be 65 years of age or older or disabled, pregnant, enrolled in or entitled to be enrolled in Medicare Part A, or enrolled in Medicare Part B, provided you meet the income level requirement.
Adults without dependent children can also qualify for Medicaid under the new rules. They were previously excluded unless the state obtained a waiver or funded the coverage using only state money. People with disabilities who are currently in the two-year waiting period for Medicare could also be eligible for the expanded Medicaid coverage. For parents who become eligible for Medicaid under the new rules, their children must also have health insurance.
Beginning in 2014, all states must use the new modified adjusted gross income method to determine eligibility for Medicaid based on income level. Prior to that, states can use any reasonable income methodology to determine eligibility, provided that it is consistent with the objectives of the Medicaid program, simple to administer, and in the best interests of the beneficiary. Also states cannot use an asset test to determine eligibility for an early expansion group of Medicaid beneficiaries. Beginning in 2014 asset tests can only be used to determine Medicaid eligibility for people who are eligible because of other aid or assistance they receive, persons over 65, medically needy individuals, and those who are eligible for Medicare cost-sharing.
The Medicaid benefits provided by the states must be in accordance with what are referred to as benchmark or benchmark equivalent plans, which define the minimum services that must be covered. Prescription drugs and mental health benefits must be included.
Currently, each state can set its own income level for eligibility for Medicaid, and different states have different limits. But all states must include the expanded coverage starting in 2014. Individual states have the option to begin phasing in this new additional coverage starting April 1, 2010. As indicated by Families USA, states that currently provide Medicaid coverage at an income level below 133 percent of the federal poverty level can expand their coverage to include higher income levels. But they must use the same income level for all people eligible under the new rules, and they must expand this coverage to lower income groups before offering coverage to higher income groups.
Depending on the income level requirements your state currently has for determining Medicaid eligibility, and the matching federal funding it receives, the state may decide to expand coverage prior to 2014. You should check with your state Medicaid program to see if coverage is expanded before 2014 and you think you may be eligible. Starting in 2014 all states must provide the expanded coverage.
Alac MacGillis, “Study: States will bear little cost of Medicaid expansion under health-care law” – The Washington Post
Christopher Weaver, “Medicaid Expansion Now Could Save Some States Money” – Kaiser Health News
Dan Diamond, “Seeking Answers on Medicaid Expansion” – California Healthline
Early Medicaid Expansions Under Health Reform – Families USA
New Option for Coverage of Individuals under Medicaid – Centers for Medicare and Medicaid Services