Is Medicaid Expanding in Your State?

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Entrusted Legacy Law

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Feb 24, 2023

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As of late 2022, more than 84 million people were enrolled in Medicaid — a number that has steadily increased in recent years. Amid the pandemic, total enrollees climbed by 20 million people from 2020 to 2022 alone. 

Meanwhile, the debate among lawmakers on further expanding Medicaid in some 11 states continues to evolve. Depending on where you reside, passage of such an expansion could mean you become newly eligible for Medicaid. 

What Is Medicaid?

Medicaid is a nationwide program designed to provide public health insurance for low-income individuals, including seniors and people with disabilities. Established in 1965, it serves today as the single-largest source of health coverage in the U.S.

Because Medicaid is jointly run by the federal government and state governments, its benefits — and your ability to qualify for them — can vary greatly depending on your state. 

As a result, certain populations, even if they’re living in poverty, may not be eligible for Medicaid. For example, in some states, a healthy, childless adult couple under age 65 with limited means may not qualify for health coverage through Medicaid if their state hasn’t adopted Medicaid expansion. 

What Is Medicaid Expansion?

Medicaid coverage across the country has evolved since the program was first created. Different states may employ different eligibility criteria, income limits, or application requirements.

In 2010, the Affordable Care Act (ACA) attempted to expand Medicaid coverage to adults between 18 and 65 with incomes below a certain level, regardless of their age, family status, or health. The ACA also sought to supply those whose incomes fell within specific limits with premium tax credits that would help them afford the purchase of a private insurance plan. 

Yet, the Supreme Court ruled that the federal government couldn’t force states to expand coverage. States can decide whether to expand Medicaid to cover more people. This has created a coverage gap: Those who have incomes below 100 percent of the federal poverty level and who live in states that have opted against expanding Medicaid may not qualify for Medicaid, or for the premium tax credits. 

Medicaid Expansion States

As of early 2023, most states have adopted the ACA’s broadening of Medicaid. Per the Kaiser Family Foundation, the following states – in addition to the District of Columbia – have expanded Medicaid coverage per the ACA: 

  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut 
  • Delaware
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia 

States Without Medicaid Expansion 

States that haven’t adopted Medicaid expansion per the ACA include:

  • Alabama
  • Florida
  • Georgia
  • Kansas
  • Mississippi 
  • North Carolina
  • South Carolina 
  • Tennessee
  • Texas
  • Wisconsin 
  • Wyoming 

Medicaid Expansion Developments 

The map of Medicaid expansion states continues to evolve, however: 

  • South Dakota voters approved a ballot measure adding Medicaid expansion to the state constitution in November 2022. The expansion will go into effect beginning July 1, 2023. 
  • In February 2023, the North Carolina House of Representatives passed a bill to expand Medicaid. It now awaits review in the Senate.
  • Meanwhile, also in February 2023, the Wyoming House of Representatives declined to address a proposed Medicaid expansion bill. 

Arguments Against Medicaid Expansion 

In states without Medicaid expansion, those opposed to expanding coverage have voiced such concerns as increased costs and a higher risk of fraud. 

For example, some argue that Medicaid expansion would burden their state’s budget. Although the federal government funds the majority of expanded Medicaid, it doesn’t completely cover the costs; states pay 10 percent. In the case of Wyoming, House Majority Floor Leader Rep. Chip Neiman has raised concerns that the federal government wouldn’t uphold the federal match, leaving the state to bear more financial responsibility.

Others contend that Medicaid’s most vulnerable beneficiaries may face greater competition for resources, that other health care options are available to those in need, or that expansion may not ultimately translate into better long-term health outcomes.

How Older Adults Can Find Out if They’re Eligible for Medicaid Coverage

In states that have adopted expanded Medicaid, you may qualify if your household income lies below 133 percent of the federal poverty level, according to HealthCare.gov. 

For older adults, most states provide Medicaid to those who receive Supplemental Security Income (SSI). To be eligible for SSI, individuals must have low incomes, limited assets, and be unable to work due to a qualifying mental or physical impairment. Per the Kaiser Family Foundation, some states expand Medicaid to older adults and disabled people whose income surpasses the SSI limit but falls below the federal poverty level. 

You may be able to qualify for Medicaid through the Medically Needy program if your state has established one. The Medically Needy program allows people to enroll in Medicaid when they have significant medical expenses. When they subtract their medical spending from their total income, they can qualify for Medicaid if their income, minus health care expenses, falls below a specified limit (which also varies by state). 

To find out whether you qualify for Medicaid, consider consulting the following tools:

  • The Benefits.gov Eligibility Checker will ask you questions regarding things like household income, number of dependents, and citizenship status to help you determine whether you might be eligible for Medicaid generally. 
  • The HealthCare.gov site can offer additional insights, including:
    • Guidance on Health Insurance Marketplace applications
    • Income calculators
    • Premium tax credit information
    • Q&A tool to determine eligibility for cost-sharing reductions

Again, the rules governing Medicaid and its complex eligibility criteria varies widely by state. To find out whether you may be able to receive public health insurance through Medicaid, consult with an elder law attorney in your area.

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Maintain Control Dictate how and when your assets are distributed to your heirs.For families with complex financial portfolios, business ownership, or special circumstances (such as blended families or special needs children), we offer advanced estate planning strategies tailored to your specific goals.Can You DIY Your Estate Plan?Many people wonder if they can create an estate plan using online templates or generic legal services. Unfortunately, most DIY estate plans fail when families need them the most. What often passes for "estate planning" is nothing more than basic document generation, where you answer a few questions and receive a generic template that may not fully protect your assets or your loved ones. No Personalization A generic template cannot address your unique family dynamics, financial situation, or specific legal concerns. Legal Loopholes Improperly structured wills or trusts may be contested in court, leaving your family in legal disputes. No Ongoing Maintenance Estate laws change, and without updates, your plan may become outdated and ineffective.At Entrusted Legacy Law, we dont just draft documentswe provide comprehensive estate planning services that ensure your estate plan actually works when it matters most. We take the time to understand your familys needs, educate you on your options, and create a legally enforceable, tax-efficient, and conflict-free estate plan that gives you peace of mind.Protecting Families & Minor Children Through Estate PlanningIf you are a parent with young children, your estate plan should begin with a solid foundation that ensures your children will always be taken care of, no matter what happens. Without the proper legal protections in place, your children could end up in the custody of someone you wouldnt have chosenor worse, under state guardianship.At Entrusted Legacy Law, we specialize in estate planning for families with minor children. We help parents:Name Legal Guardians Ensure your children are raised by trusted individuals of your choosing.Set Up Trusts for Minor Children Prevent financial mismanagement by appointing a responsible trustee to oversee assets.Establish Emergency Plans Provide clear instructions for immediate care in case of sudden incapacity or death.Whether youre planning for minor children, adult dependents, elderly parents, or a complex estate, we can guide you through the estate planning process with personalized strategies to protect your familys future.Secure Your Legacy With Entrusted Legacy LawEstate planning isnt just about who gets whatits about ensuring that your loved ones are financially secure, legally protected, and prepared for the future.If you want to create a comprehensive estate plan that reflects your wishes, avoids probate, minimizes taxes, and keeps your loved ones out of court and out of conflict, then now is the time to take action  Contact Entrusted Legacy Law today at 412-547-9855 to schedule your Life and Legacy Planning Session and take the first step in protecting your family, your assets, and your future.