Medicaid Expansion

The ACA greatly expands the number of people who are eligible for Medicaid.   The law establishes a new eligibility group that all states participating in Medicaid must cover as of January 2014.


Who is eligible?

Low income individuals who are not otherwise eligible under mandatory eligibility categories and have incomes below 133% of the Federal Poverty Level.  This means that eligible people must NOT be age 65 or older, pregnant, entitled to or enrolled in benefits under Medicare Part A or Part B, SSI beneficiaries, or other mandatory groups.


What is 133% of the Federal Poverty Level?

For an individual, in 2010, it is about $14,000 per year.  It varies by size of the family as shown below:

 

1

2

3

4

5

6

7

8

133% of poverty     

$14,403  

$19,378   

$24,352   

$29,326   

$34,300   

$39,274   

$44,249   

$49,223   

 

How is eligibility changed?

Currently, to qualify for Medicaid, applicants must meet both asset and income thresholds in most states.  In 2014, there will not be an asset test when determining eligibility for this new group.  This means that things like cars, small savings accounts, or life insurance policies will not be considered when determining eligibility.  Income will also be counted differently.  Social Security benefits will not be counted as income.  This will mean that individuals newly eligible for SSDI in the 2 year waiting period for Medicare may be eligible for Medicaid during that period.
 

Does the Medicaid expansion help people seeking long term services and supports?

No.  The expansion does not change current eligibility rules for home and community based services. People must meet current rules for determining financial eligibility including any asset test used in their state and the standards for having a disability and qualifying for services.
 

When does the coverage expansion take effect?

In 2014 all states must expand coverage.  However, the Centers for Medicare and Medicaid Services (CMS) has provided guidance allowing states to start earlier and to phase in coverage beginning in April, 2010.
 

Who is paying for the expansion?

The federal government is paying 100% of the extra costs of cover the newly eligible individuals for the first three years.  After 2016, the federal share goes down to 90%.