Eligibility Loophole Lets Middle-Income Earners Qualify for Medicaid
A change in the way Medicaid eligibility is determined could allow as many as three million middle-income early retirees to qualify for the program in 2014, according to Medicare Chief Actuary Richard Foster, AP/Yahoo! News reports.
Under the federal health reform law, an individual's modified adjusted gross income -- a calculation that excludes some Social Security benefits -- will be used to determine Medicaid eligibility. The health reform law increases the income eligibility limit to 133% of the federal poverty level to be eligible for Medicaid. Currently, the federal poverty level for a couple is $14,710. Retirees are eligible for Social Security at age 62, but they must wait until they are 65 to qualify for Medicare, unless they are disabled (Alonso-Zaldivar, AP/Yahoo! News, 6/21).
Foster said that hypothetically, a married couple who retired early and receive Social Security benefits of about $25,000 a piece could be eligible for Medicaid if the remainder of their income was less than 133% of the poverty level, even though their total income, including benefits, would be well above the threshold (Adams, CQ HealthBeat, 6/21).
HHS Assistant Secretary for Public Affairs Richard Sorian on Tuesday said, "We are concerned that, as a matter of law, some middle-income Americans may be receiving coverage through Medicaid, which is meant to serve only the neediest Americans. We are exploring options to address this issue" (AP/Yahoo! News, 6/21).
Republicans Say Provision Reflects Larger Problems in the Health Reform Law
Many Republicans have expressed concern about the provision. The Republican Governors Association on Tuesday released a statement saying that the eligibility loophole "will boost Republican governors' argument that [rules in the federal health reform law] concerning Medicaid don't make sense" (CQ HealthBeat, 6/21).
Former Utah Gov. Mike Leavitt (R) --Â who served as HHS secretary under President George H.W. Bush --Â said "the fact that this is being discovered now tells you, what else is baked into this law? It clearly begins to reveal that the nature of the law was to put more and more people under eligibility for government insurance" (AP/Yahoo! News, 6/21).