When the Affordable Care Act (ACA) passed in 2010 it mandated that states expand existing Medicaid eligibility to all US citizens up to age 65 with incomes below 133% of the federal poverty level (FPL) (include hover function for FPL). The law intended to expand Medicaid eligibility primarily to childless adults, considering in many states they were not eligible. It also raised the income eligibility level for parents and in some cases, significantly. Currently, Medicaid covers people based on a state’s income eligibility criteria.
However in June 2012, the US Supreme Court ruled that expansion of Medicaid eligibility by states was optional. Thus, states could continue with their current Medicaid eligibility levels without risk of being penalized or excluded from the Medicaid program by the federal government. As a result, 22 states have opted against expanding Medicaid eligibility beyond the eligibility level in 2013, which will lead to “coverage gaps” in many of these states. Individuals falling into the “coverage gap” are neither eligible for Medicaid, nor are they eligible to receive premium tax credits to purchase an individual health insurance plan through the health insurance Marketplaces. While they will not be penalized for not having qualified health coverage under the ACA, they will remain uninsured and potentially lack access to quality health care.
A handful of states not expanding their Medicaid program have attempted to address the coverage gap for adults who make less than 100% of the FPL. For example, Wisconsin, expanded its income eligibility level for parents and other adults from 95% to 100% FPL. Other states, including Pennsylvania and Indiana, have proposed alternative methods of expansion in an effort to close the gap. However, such proposals must be approved by the Center for Medicaid and Medicare Services (CMS) before they can be implemented and would not be implemented until 2015.
Some states have other safety net programs in place to ensure access to some form of health care for uninsured individuals; however, states may be looking to eliminate or reduce current safety net programs with the implementation of health care reform.
Persons with hemophilia or related bleeding disorders who fall into these coverage gaps may continue to lack access to life-saving clotting factor therapies and to a primary care doctor and/or hemophilia treatment center (HTC). As a result, they will be unable to develop or adhere to a recommended treatment plan and may have significantly more bleeds, require hospitalization or suffer other related complications. Such events can significantly burden the health care system and end up costing states more money in the long run.
NHF remains dedicated to advocating for expansion of Medicaid in every state. We continue to work with local chapters to develop talking points and advocacy strategies to encourage their states to expand Medicaid.
Kaiser Family Foundation (KFF) has a number of up-to-date interactive resources:
- Interactive: A State-by-State Look at How the Uninsured Fare Under the ACA. This interactive allows users to identify the total number of adults and children that would be eligible for Medicaid/CHIP by state. It also allows users to access state specific data about the number of individuals (adults and children) that fall into the gap.
- The full listing of Medicaid specific resources available through KFF including issue briefs, infographics, and reports.
- The recently updated Medicaid.gov: includes policy and program specific information about Medicaid, CHIP and the Basic Health Program. There are numerous state resources including: