The Medicaid program is jointly funded and run by the federal government and the state governments.
This has resulted in a Medicaid coverage gap in some states.
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What Is the Medicaid Coverage Gap?
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As a result, they effectively have no realistic health coverage options.
There was never supposed to be a coverage gap, and it is not part of the ACA.
Who Is in the Coverage Gap?
In states that have not expanded Medicaid, the pre-ACA rules continue to be used to determine Medicaid eligibility.
So most nondisabled adults in those states cannot enroll in Medicaid unless they have minor children.
But in nine of the 10 states listed above, the adults would not be eligible for Medicaid.
Ten states have not expanded Medicaid, including Wisconsin.
What Is Medicaid Expansion?
Before 2014, Medicaid eligibility was quite limited and depended on more than just income.
But a lawsuit over the ACA was soon launched, challenging various parts of the law.
In 2012, the Supreme Court ruled that the ACA itself was constitutional.
But the Supreme Court ruled that the Medicaid expansion provision in the ACA would be optional for states.
Over the years since then, several additional states have expanded eligibility for Medicaid for low-income adults.
Some have done so through legislation, and others have used voter-approved ballot measures.
Their assets/resources are not considered, andeligibility is just based on income.
However, there are still 10 states that have not expanded Medicaid under the terms established by the ACA.
In nine of those states, many low-income adults have no realistic coverage options.
for less than five years.
This combination of ineligibility for Medicaid and ineligibility for premium subsidies creates a coverage gap.
You may find that you do qualify after all.
For example, youre a single adult applying for marketplace coverage for 2023 in Alabama.
They can do this at any time by accepting federal funding to expand Medicaid.
The federal government will always pay at least 90% of the cost of covering the newly eligible population.
The American Rescue Plan also provides additional federal funding to any states that newly expand Medicaid.
(In both states, this was due to ballot measures that voters approved in 2020.)
The 10 states with coverage gaps have continued to steadfastly refuse to expand Medicaid.
So Congress has also been working to create a federal solution.
This means the subsidy would cover the entire cost of thebenchmark plan(second-lowest-cost silver plan).
This would be a huge improvement.
But again, the future of the Build Back Better Act is uncertain as of 2023.
The version that passed the House did not have enough support to pass in the Senate.
But there are a dozen states that have refused to expand Medicaid.
In 10 of them, adults with income below the poverty level are often ineligible for Medicaid.
But the future of this legislation is uncertain as of 2023.
Many adults with income below the poverty level are not eligible for Medicaid in these states.
Medicaid expansion was created by the Affordable Care Act.
As of late 2023, the District of Columbia and 40 states have expanded Medicaid.
There are no asset tests for Medicaid expansion, as eligibility is based on income alone.
The federal government pays at least 90% of the cost of covering the newly eligible population.
KFF.Status of state Medicaid Expansion decisions: interactive map.
Center on Budget and Policy Priorities.Record low uninsured rate offers roadmap to long-term coverage gains.
Department of Health and Human Services.U.S.
federal poverty guidelines used to determine financial eligibility for certain programs.
Centers for Medicare and Medicaid Services.Medicaid, Children’s Health Insurance Program, & Basic Health Program eligibility levels.
Centers for Medicare and Medicaid Services.Oklahoma’s Medicaid expansion will provide access to coverage for 190,000 Oklahomans.
Centers for Medicare and Medicaid Services.Missouri Medicaid expansion brings quality essential health coverage to more than 275,000 Missourians.
House of Representatives.H.R.5376 - Build Back Better Act 117th Congress (2021-2022).
KFF.Potential costs and impact of health provisions in the Build Back Better Act.
The Hill.Pelosi sidesteps progressives' March 1 deadline for Build Back Better.
