Some Medicaid Enrollees Could Lose Coverage as States Modify Programs
As many states prepare to expand their Medicaid programs under the Affordable Care Act, tens of thousands of residents of other states could lose their Medicaid coverage as those states shift beneficiaries into subsidized private plans or experimental versions of the program expire, the Washington Post reports (Aizenman, Washington Post, 4/6).
The ACA expands Medicaid income eligibility to 138% of the federal poverty level. The Supreme Court's ruling on the ACA allows states to choose whether to participate in the expansion.
For states that opt in, the federal government will cover 100% of the cost of the expansion until 2016, and after that the federal contribution will decline gradually until it reaches 90% in 2020 (California Healthline, 3/15).
However, a proposal by Wisconsin Gov. Scott Walker (R) could mean 95,000 adults in Wisconsin lose Medicaid coverage.
Wisconsin currently has one of the most generous Medicaid programs in the country. Under Wisconsin's Medicaid program, adults with children -- and even some without -- are eligible at up to twice the poverty level, or $47,100 for a family of four.
Walker's proposal would set the cutoff for Medicaid eligibility in the state at the federal poverty level, or $23,550 for a family of four, and expand coverage to all adults with incomes up to that level.
While the ACA would provide subsidies to help those adults purchase coverage through the law's health insurance exchanges -- which officials from the Walker administration say could mean monthly premiums as low as $19 -- some observers are concerned that other expenses, such as copayments and deductibles, could make the cost of such coverage prohibitive.
Proposals in Other States
Meanwhile, Maine will scale back its Medicaid program, reducing eligibility from 138% of federal poverty level to 100% of the federal poverty level beginning in 2014. As a result, 14,500 current beneficiaries will no longer be eligible for Medicaid.
In addition, a total of 180,000 individuals in five other states are currently enrolled in experimental versions of Medicaid that will end this year and might be not be renewable under the ACA. For example, 44,000 Indiana residents are covered under an experimental plan that covers individuals with incomes up to 138% of the poverty line through high-deductible plans.
However, the state's federal waiver for the program expires Dec. 31 and all of those beneficiaries will lose coverage if the Obama administration does not grant a new waiver.
Likewise, about 70,000 Iowa residents, almost 30,000 Oklahoma residents and 20,000 Utah residents are receiving Medicaid coverage through a similar waiver that will expire this year.
Judith Solomon, a health policy analyst at the Center on Budget and Policy Priorities, said it will be difficult for states to have their waivers renewed because the experimental programs were designed as alternative methods for furthering the ACA's goals and they are offering less coverage to state residents than under the ACA's Medicaid expansion (Washington Post, 4/6).
Ex-Prisoners Eligible for Medicaid Coverage
In related news, about 650,000 individuals with a criminal conviction who are released from state and federal prisons annually will be eligible for coverage under the ACA's Medicaid expansion starting in January 2014, Stateline/Kaiser Health News reports.
States currently are only required to provide Medicaid coverage to children, pregnant women and individuals with disabilities. However, states that opt in to the expansion will be required to cover all low-income adults under age 65.
Researchers and advocates say the change will help to reduce health care costs, address ex-convicts' general poor health and possibly prevent incarceration for some.
Faye Taxman, a health services criminologist at George Mason University, said, "We now have a golden opportunity to develop and implement quality interventions to both improve health outcomes for this population and also reduce the rate of criminal activity" (Ollove, Stateline/Kaiser Health News, 4/5).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.