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ObamaCare Medicaid Expansion is one of the biggest milestones in health care reform. ObamaCare's Medicaid expansion expands Medicaid to our nations poorest in order cover nearly half of uninsured Americans. The law previously required states to cover their poorest or lose federal funding to Medicaid (federal funding covers 90-100% of state costs) until the supreme court ruling on ObamaCare. State's can now opt-out of Medicaid Expansion leaving millions of poor working families without coverage.
States opting out of the expansion of Medicaid under ObamaCare is projected to drive up insurance costs drastically (check out the facts below), while saving the States relatively small amounts, if anything at all. Join the ObamaCare Facts Mailing List to keep up to date on the Medicaid Expansion vote in your state.
The bottom line on Medicaid Expansion: Does the cost of Medicaid to the State outweigh the cost of unpaid hospital bills shifted to those who pay for insurance and the fact that millions of poor working families will go without proper health care creating a less healthy society who will potentially need more expensive unreimbursed care later in life?
Keep reading to find out more about Medicaid expansion under the Affordable Care Act including how to find out if you are eligible for Medicaid under the expansion and how to sign up for Medicaid through your state's health insurance marketplace.
Let's take a quick look at how ObamaCare's Medicaid expansion and how it affects American families.
Medicaid is a joint federal and state funded program that provides health care for over 60 million low income Americans.
As of 2013 every State had different eligibility requirements based on income, age, gender, dependents, and other specific requirements.
Starting in 2014 State's that expanded Medicaid increased eligibility levels to 138% of the Federal Poverty Line ($23,550 for a family of four). All states that expanded Medicaid have uniform eligibility requirements.
Since every State covers those who have no income, expansion would almost exclusively be covering the working poor and their families.
Poor working families are the most likely to not have insurance do to affordability, Medicaid expansion helps "covers the gap" between current Medicaid eligibility and families being able to afford private health insurance using marketplace subsidies.
About half of the uninsured in America would be covered by Medicaid Expansion if all states opt-in.
Millions of Americans will be able to get care before they are forced to use costly last minute emergency services in state's that support expansion.
The uninsured currently cost hospitals billions in unpaid hospitals bills, these costs are indirectly passed onto the average taxpayer with insurance.
Unpaid hospital bills to hospitals are one of the main causes of rising premium costs.
The Federal Government pays 100% of expansion costs for the first three years and 90% thereafter until 2022.
Many State's have shown that Expanding Medicaid actually raises money for the State.
Cost is the most cited reason for not expanding Medicaid. While current Medicaid programs do costs state taxpayers a lot of money, that spending is balanced by unpaid hospital bills and the affect those bills have on the rising costs of premiums.
Every State who opt-ed out of expansion has a Republican governor that is against the program.
Most of the State's who opt-ed out have the highest uninsured rates and are the State's expansion would help the most.
State's opt-ing out of Medicaid expansion is part of an ongoing effort to "break" ObamaCare regardless of the cost to the people. Other tactics include opt-ing out of creating exchanges, expensive disinformation campaigns, and a Government shutdown.
States had until January 2014 to decide if they would expand Medicaid. Many states are not moving forward with the program at this time, however they can still decide to expand Medicaid later.
States expanding Medicaid – AZ, AR, CA, CO, DE, DC, HI, IL, IA, KY, MD, MA, MN, MA, NV, NJ, UT, NM, NY, ND, OR, PA, RI, VT, WA, WV, States not expanding Medicaid – AL, AK, FL, GA, ID, IN, KS, KY,LA, ME, MS, MO, MT, NE, NC, OK, SC, SD, TX, VA, WI, WY
States that have not yet decided NH, OH, TE
Know the Law. The Affordable Care Act contains 10 titles, each title addresses a different aspect of health care reform. Title II - The Role of Public Programs addresses Medicaid expansion. Check out our Summary of Provisions of the Patient Protection and Affordable Care Act for a plain English summary of each provision pertaining to the Affordable Care Act and Medicaid expansion.
Unfortunately, when the NFIB took the Affordable Care Act to the supreme court in an attempt repeal it, the Medicaid expansion requirement was overturned leaving millions without access to health insurance.
Since the ruling each state can decide whether or not they want to opt out of expanding coverage to their poorest with no penalty to funding. The new ruling doesn't just hurt Medicaid and ObamaCare, it affects the tax payer by forcing us to pay for states that choose not to help their poorest. Even though expanding Medicaid would have cost the federal tax payer, states and tax payers are still picking up the tab on those who fall through the "Medicaid gap" as these individuals will either use emergency services or purchase subsidized health insurance through the marketplace using federal tax credits. In other words while it potentially saves the state money, it leaves millions without insurance and still shifts costs federal tax payers.
National Federation of Independent Business (NFIB) is an "independent" group that represents "small business". However, they historically follow the Republican party line and fight against "entitlement" programs like ObamaCare's Medicaid Expansion that help the nations poorest working families and the majority of smaller businesses.
Remember the only businesses that pay more under ObamaCare are the top 3% of small businesses and big businesses. Learn More About Small Business and ObamaCare.
Nearly ONE HALF of uninsured Americans were going to get their health insurance under ObamaCare Medicaid reform by expanding coverage to the nations' poorest starting in 2014. Now states can opt-out without losing federal funding.
Medicaid is a joint federal and state funded program that provides health care for over 60 million low income Americans, mostly children, pregnant women, people with disabilities and elderly people who need help or live in nursing homes.
Since Medicaid is a program that works partly on a state level with help from the federal government the rules alter from state to state, but the rule of thumb is that most low-income adults under 65 cannot currently receive Medicaid.
Medicaid works differently in every State. The eligibility guidelines for Medicaid are set by the Federal Government and then some State's choose to expand them. This is how it worked before ObamaCare and due to the Medicaid expansion opt-out it still works this way today.
• To be eligible for coverage, a person must belong to an eligible group (generally: children, pregnant women, parents, blind or disabled persons, and the elderly) and meet the financial eligibility requirements for that group.
• Prior to the ACA, the federal government already mandated that eligibility levels for children and pregnant women be at least 100-133 percent (see table below), but eligibility levels for parents could be much lower, and states were not required to cover adults without dependent children at all.
• As of December 2009, eligibility levels for parents in 17 states were at or below 50 percent FPL (which is $11,725 for a family of four in 2012). Another 17 states set eligibility levels for parents at or below 100 percent FPL (which is $23,550 for a family of four in 2013).
• As of December 2009, only five states allowed adults without dependent children to enroll in Medicaid, although two of those states plus another 14 states offered some limited set of benefits to some childless adult.
• The eligibility requirements of Medicaid leave about 20 million people in the gap between affording insurance and being eligible for Medicaid.
• Children who don't qualify for Medicaid may qualify for CHIP (Children's Health Insurance Program) which works closely with Medicaid.
• Medicaid can also help Seniors If you qualify for Medicaid in your state, you automatically qualify for extra help paying your Medicare prescription drug coverage (Part D). Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services.
Medicaid works closely with the Children's Health Insurance Program (CHIP). Learn more about ObamaCare and the Children's Health Insurance Program (CHIP)and see if your child qualifies.
Medicaid expansion expands Medicaid eligibility to all individuals and families below the 138% Federal Poverty Level. This includes many groups (like single men) those who weren't previously eligible.
Eligibility for Medicaid Expansion is decided on state by state. In State's that do expand Medicaid all legal residents who earn less than $15,302 for individuals and $31,155 for a families of four can receive Medicaid under Medicaid Expansion. In State's that don't expand Medicaid, eligibility only includes a very limited cross section of the population and income levels as low as 50% FPL. People covered under the expansion also include:
Low income adults with or without dependent children
Low income children who lose their Medicaid benefits when they are reclassified as adults 19 years.
Low income adults with disabilities who are not eligible for SSID or SSI.
The following table is an example of eligibility levels for different groups by % of Federal Poverty Level (FPL)
|Categorical group||U.S. minimum threshold pre-ACA, 2009*||State thresholds, 2009: medians, (ranges)||U.S. minimum thresholds under ACA, 2014**|
|Children 0-5||133% FPL||235% FPL
(133-300% FPL )
|Children 6-19||100% FPL||235% FPL
|133% FPL (note traditional vs new)|
|Pregnant women||133% FPL||185% FPL
|Working parents||State's July 1996 AFDC eligibility level^||64% FPL
|133% FPL (note traditional vs new)|
|Non-working parents||State's July 1996 AFDC eligibility level^||38% FPL
|133% FPL (note traditional vs new)|
|Childless adults||Eligibility not mandated. State must apply for waiver to cover this group.||0% FPL
(0% FPL in 46 states; 100-160% FPL in 5 states)
|133% FPL (note traditional vs new|
|Elderly, blind, disabled||Receipt of SSI^||75% FPL
|Receipt of SSI|
New York, Arizona and Maine expanded Medicaid between 200 and 2005. A Harvard study reports, "rates of uninsured residents dropped, access to care improved, and more people reported being in very good or excellent health". The coverage was estimated to save a total of 2,840 lives a year for the states.
Medicaid expansion would provide access to health insurance for almost half of our nations uninsured.
Letting states Opt-out of ObamaCare's Medicaid expansion not only leaves millions without coverage, it also costs taxpayers money.
Uninsured Americans cost tax-payers money because they use costly emergency services instead of getting the preventative care they need.
In State's that don't set up a marketplace or expand Medicaid Federal tax dollars are used to subsidize many who would have been eligible for Medicaid under expansion. Medicaid costs are shared between the State and Federal Government.
Sometimes we say Medicaid is expanded to the 133% and sometimes we say 138%. Both are correct. The text of the ACA says 133%, but the law also calls for a new methodology of calculating income, which will make the effective minimum threshold 138%. (Either way, remember that these are minimum thresholds; states can set eligibility thresholds higher, and many already have for certain populations, which means that more people qualify.)
Selected federal poverty level (FPL) thresholds in terms of annual income, 2012. Please note that ObamaCare uses the 2013 Federal Poverty Guidelines so the dollar amounts are slightly higher than shown below.
|FPL||Individual||Family of four||Relevance|
|50%||$5,585||$11,525||Currently (prior to the ACA Medicaid expansion), parents in 17 states don't qualify for Medicaid unless their incomes are below this threshold. (Eligibility levels for children are higher, so in a given family, children may qualify while parents don't.) In nearly all states, childless adults are ineligible regardless of income.|
This is the official poverty threshold, updated each year by the federal government. It varies by family size and composition.As written in the ACA, persons with family incomes below this threshold are not eligible for subsidies to purchase insurance in the exchanges. In states that don't expand Medicaid, individuals with incomes above their state's current eligibility level, but below 100 percent FPL, will not qualify for anything.
|As written in the ACA, this will be the new minimum eligibility threshold for nearly everyone under 65. However, the effective threshold will actually be 138%. See next line.|
|$15,414||$31,809||Even though the ACA states that the new threshold is 133%, it will effectively be 138%, because 5% of people's income will be "disregarded." See below for more information.|
|$92,200||This will be the upper limit for eligibility for income-based subsidies for the purchase of private insurance through the new health insurance exchanges.|
In the past applying for Medicaid meant you needed to meet certain criteria such as being pregnant, having a child or having a disability and usually meeting some sort of income requirement. In State's that have implemented expansion the only main requirement is that you make less than 133% of the Federal poverty level.
Since the guidelines are so complicated, the easiest way to find out if you are eligible for Medicaid is to fill out an application at your State's health insurance marketplace. Read our guide to the Health Insurance Exchanges to find out more about using your State's online marketplace to sign up for insurance. The application process will notify you if you are eligible for Medicaid.
Sign Up for Medicaid Now
Each state has different rules about eligibility and applying for Medicaid. You Can use one of the two following methods to apply for Medicaid:
1. Visit your State's Health Insurance Marketplace by finding it on our list.
2. Call your state Medicaid program to see if you qualify and learn how to apply.
ObamaCare opponents use the downfalls of Medicaid as terms to reject Medicaid Expansion. Drawbacks of Medicaid include: limited access to health care, low-end quality healthcare and coverage and low doctor payouts. ObamaCare's reforms address many of the issues with the quality of Medicaid since it's provisions increase the quality of care for all types of insurance and it also contains provisions to increase doctor payouts as well!
Doctor payouts have been historically low. Due to low payouts, many doctors don't take Medicaid and the quality of care tends to be poor. However, ObamaCare's Medicaid Reforms do a lot to change this.
The ObamaCare Medicaid reforms that come with ObamaCare's Medicaid Expansion include raising the amount doctors get paid to the same level of Medicare (73%) and increasing payments to Medicaid programs that offer preventive services for free or at little cost. New free preventive services include tests for high blood pressure, diabetes, and high cholesterol; many cancer screenings, including colonoscopies and mammograms; counseling to help people lose weight, quit smoking or reduce alcohol use; routine vaccinations; flu and pneumonia shots; and other services.
The ObamaCare Medicaid reforms were meant to expand coverage to up to 21.3 million of our nations' poorest. The law had said, prior to the supreme court hearing, that very low-income individuals (those under the 133% FLP line) including adults without dependent children. Even though Medicaid is a federal and state joint program the funding for low income individuals was covered 93% over the next decade by the federal government using tax payer money.
Medicaid Expansion means, in all States, individuals with annual incomes up to 133% of the federal poverty line -- currently, $14,856 or less -- are able to enroll. Right now eligibility differs from State to State.
If a state refused to expand coverage then it would lose all of it's Medicaid funding. This was meant as a protection to ensure that states supported their poorest equally. However, the NFIB 'Repeal ObamaCare Effort' worked to some extent; now states are no longer required to insure their poorest under ObamaCare, yet they can still receive the full federal funding for their Medicaid program.
States can now opt-out of Medicaid for it's poorest without losing any federal funding.
The supreme court decided that states have the right to opt-out of Medicaid for it's poorest without losing any federal funding. This may seem fair or harmless, but the implications of this are dire. This will leave many of the nations poorest without health insurance come 2014. ObamaCare Medicaid reform was meant to cover 17 million of our poorest through Medicaid and millions of higher income individuals through Medicare and the Online Health Insurance Exchange Marketplace. Now millions of people may go without health insurance.
If You Don't Want Your State To Reject Medicaid Expansion For Your State's Poorest. Vote For ObamaCare Supporters on A State Level.
Texas opting out of Medicaid Expansion leaves 1.1 million Texans with no coverage due to the Medicaid coverage gap.
If the states decide to Opt-Out of Medicaid expansion, ObamaCare itself will have to step up to the plate and insure these individuals via the ObamaCare Health Exchanges. The problem is that this will likely raise everyone's health insurance, including those with private insurance.
This means that anti-ObamaCare states who reject Medicaid will not only hurt their poorest, it will affect every tax paying American and every American who has health insurance.
If all states move forward with ObamaCare's Medicaid Expansion they will collectively pay $76 billion (a 3% increase) to insure up to 21.3 Million individuals who don't have access to health insurance (about half of the nations uninsured) over the next decade. Obviously, those who have more to cover will have to spend more. Regardless of what a state spends, the Federal Government covers 93% of the States' costs. State spending increases are relatively small compared to what States would pay without ObamaCare or to the 26% increase that the federal government will pay towards Medicaid.
Here are some detailed facts on Medicaid expansion:
The federal government will pay a very high share of new Medicaid costs in all states. 100% of costs are covered for the first year. 90% of the spending is done by federal government moving forward.
Increases in state spending are small compared to increases in coverage and federal revenues, and relative to what states would have spent if reform had not been enacted.
ObamaCare Medicaid Expansion sets the eligibility level for Medicaid at 133% FLP, although there is a special deduction to income equal to five percentage points of the poverty level raising the effective eligibility level to 138% of poverty.
The legislation maintains existing income counting rules for the elderly and groups eligible through another program like foster care, low-income Medicare beneficiaries and Supplemental Security Income (SSI).
The NFIB helped to change the Affordable Care Act to include a "state opt-out" for Medicaid Expansion.
In combination with ObamaCare's other provisions, if all states participate in Medicaid expansion, it would reduce the number of uninsured by 48%, relative to the number of uninsured without the ObamaCare. States with higher uninsured rates prior to the ObamaCare would see larger increases in Medicaid and bigger reductions in the uninsured, compared to states with lower pre-ObamaCare uninsured rates.
If all states implement the expansion, an additional 21.3 million individuals could gain Medicaid coverage by 2022, a 41% increase compared to Medicaid without the ObamaCare. With many States opting out, the number is expected to fall below 15 million.
Medicaid Expansion covers those who are most likely to use emergency services that cost hospitals tens of billions in unpaid hospital bills.
States will spend little to nothing expanding Medicaid. For example, it would cost the State of Florida about $5 a year per person to cover all uninsured below the 138% FLP.
Low-income families and other Americans who would be eligible for Medicaid will fall between the cracks without expansion (as they do now). ObamaCare will most likely have to insure them in the ObamaCare health exchanges. This is projected to drive up the cost of insurance for all Americans by a great deal.
Big Business-backed groups like ALEC and the NFIB frequently suggest legislation that seeks to dismantle public programs at a state level. They tend to achieve this in Red states where they have the most pull. These states need Medicaid the most as they have the most low-income individuals falling through the cracks. They will also put a bigger burden on everyone else as it will cost more to insure their poorest on the marketplaces.
If Medicaid Expansion is Opted-out of by too many states, it will greatly diminish the effectiveness and affordability of ObamaCare. Stop your state from Opting out of Medicaid by helping to share the ObamaCare Facts.
The federal government will pay for most (90% - 100%) of the Medicaid expansion when it is implemented in 2014, but states would be required to pay for up to 10% percent of it by 2020.
Some States, are saying that paying 0% - 10% of the Medicaid expansion as laid out under ObamaCare will cost them too much. While some States will pay more, the increase is very small (3% average increase in Medicaid Spending), even for the States who will pay the most. Keep in mind emergency room visits cost the State tax payer millions, while the burden of Medicaid is split between the Federal Government and the State. Therefore most State's would save money over the first 3 years of expansion at the least.
A Harvard case study found that states who had expanded their Medicaid programs from 2000 to 2005 improved health care for the State and saved thousands of lives.
Some States are expected to save Billions from ObamaCare's Medicaid Expansion.
The supreme court decision not to repeal ObamaCare (brought to the supreme court by NFIB) says that states can reject Medicaid for their poorest (leaving up to 7% of their states poorest uninsured).
Why would a state want to reject Medicaid? It's because they don't have to reject the funding, they just can opt not to funnel it to poor people. This drives the cost of health care up for the rest of the country and makes ObamaCare less effective.
Many of the State's that reject Medicaid Expansion are those who need it the most. Uninsured rates tend to be higher in Red States. In Texas for example 25% of it's population is uninsured, Texas opt-ed out of Medicaid Expansion and creating a health insurance marketplace.
Want to know which states will insure the 15 million Americans below the poverty line and which States will leave the rest of the 21.3 million uninsured behind? Find out which states support their state's poorest. Want more information on ObamaCare and Medicaid Expansion? Get the Full KKF Medicaid Expansion Report.
This list is kept up to date, however which states expand Medicaid is subject to change. Even if you are not eligible for Medicaid you may be able to get very low cost health insurance through your state's health insurance marketplace due to cost assistance subsidies.
* indicates a state's participation in the multi-state lawsuit against ACA
Go Here For Governor's Statements on the Medicaid Expansion
While states like Florida and Colorado say that a 3% increase in spending is too much, states like Michigan are showing that the States can actually save money by adopting the Medicaid expansion.
The nonprofit Center for Healthcare Research & Transformation projected the net costs of Michigan expanding Medicaid under the health system reform law. In all three scenarios of enrollment uptake assumed by the researchers, the state would reduce both overall spending and the numbers of uninsured residents. Figures represent the state’s 10-year cost savings, in millions, under moderate projections for the enrollment of newly Medicaid-eligible residents in 2014, the expansion’s first year.
$1,861 million: Reduction in non-Medicaid mental health spending
$504 million: Reduction in prisoner inpatient medical spending
$444 million: Increase in tax revenues from health facilities and professionals
$395 million: Savings from elimination of Adult Benefit Waiver program
$23 million: Reduction in state employee health spending
$3,228 million: Total state budget savings
$2,245 million: Gross state expansion costs
$983 million: Net state budget savings
Note: Savings amounts do not add up to total savings due to rounding.
Source: “The ACA’s Medicaid Expansion: Michigan Impact,” Center for Healthcare Research & Transformation, October
Big business pays big money to move federal programs to a state level so they can reject portions of the bill they don't like that affect the states they operate in. They use this tactic to degrade the program as a whole and weaken it at a federal level, making them less effective. This gives legislators grounds to privatize and dismantle these programs while creating tension between the states themselves.
Moving Government programs to a state level is an age-old tactic used by Big Business under the guise of being "Libertarian or Federalist". The true intension is to dismantle popular Government programs like Obamacare and Social Security on a state level via legislation drafted by groups like ALEC.
ObamaCare's Medicaid expansion, if it passes in all 50 states, will help half of the nations uninsured get access to health care. If we don't support Medicaid Expansion on a state level our nations poorest will go without healthcare. This will drive the cost up for the rest of us and create a great imbalance between states, tension and unrest. There is nothing that is more damaging to our democracy then dividing the states. Although many State's have already decided to opt out of Expansion it is not too late to show your support. If you believe in health care reform, support Obamacare's Medicaid Expansion in your state.