Medicaid Expansion: What Might It Mean for You?
Entrusted Legacy Law
Mar 03, 2023
Pennsylvania - Greater Pittsburgh Area
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As of late 2022, more than 84 million 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 your attorney.
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Elder Law 100 Pinewood Lane Suite #303, Warrendale, Pennsylvania, 15086Our Firm Prepares You for Life What makes our firm different is that we were built with the needs of growing families in mind. We understand you are BUSY, you are growing, you are planning for a life of prosperity and you value ease, convenience and efficiency. You are raising children, and caring for elderly parents, while also working hard to build your own nest egg for a lifetime of support. You want to know youve made the best decisions for your family and that your plan will work when your loved ones need it most. You want to make sure your minor children would be raised by the people you choose, and never by anyone you wouldnt want, and that your teens and adult children are properly prepared to care for you and what you leave behind. You want to feel confident that youve made the right choices, and handled everything so that you arent leaving behind a mess, when something happens. That is our focus as well. Weve developed unique systems to give you the same access to a Personal Family Lawyer as was previously only available to the super-wealthy, so you can have the guidance you need to build and maintain a life of prosperity and wealth. And, to keep your family out of court and out of conflict, which is the greatest risk to the people you love and all you have created, even if youve already worked with a traditional lawyer or created documents online. Our Team Is Here for You We encourage communication with our clients. In fact, weve thrown out the time clocks so you never have to be afraid to call with a quick question. Everything we do is billed on a flat-fee basis, agreed to in advance, so there are never any surprises. We have a whole team to serve you. When you call our office to ask your quick question, you wont have to wait hours or days for a phone call back. Youll get your question answered, right away. And, if you need to schedule a more in-depth legal or strategic call with your Personal Family Lawyer, a call will be scheduled when you're both available and ready for the call so we can make the very best use of your time and not waste your time by leaving voicemail after voicemail back and forth. And, we ensure the most important details of your planning are followed through on and your plan continues to work throughout your lifetime. We have a funding coordinator to ensure your assets are owned the right way throughout your lifetime and none of your assets will end up going through a long, expensive court process or being lost to the state because they were missed after your death. Weve created unique membership programs to keep your plan up to date year in and year out as well as give you access to our Trusted Team of Legal Experts for guidance on ANY legal or financial matter. One day you will need a lawyer. I dont know why and I dont know when, but when you do, you will be grateful you can call on us and well be here to advise you or get you out of a jam. We Help You Transfer Your Life and Legacy Lastly, we believe your financial wealth is only a small part of your overall Life and Legacy Planning which is made up of your far more valuable and most often lost upon incapacity or death intellectual, spiritual and human assets. These assets are what make you who you are, and sum up whats most important to you. And, a survey of inheritors has revealed that what they care about even more than inheriting your money, is inheriting these intangible assets. Most estate plans only focus on the transfer of your financial wealth to the next generation. Most people have such great intentions of passing on the intangible, but very few ever get around to it. Its just not a priority, until its too late. How much do you know about your grandparents values? Their most prized personal possessions? How they felt about you? What they had learned during their lifetime? If you are like most people, you know very little. Thats why we build the capture and passage of these most valuable assets into every estate plan we create. Not only will we help you pass on your money, but also your values, your insights, your stories and your experience the truly valuable assets your loved ones care about the most. Weve developed a tool that allows us to capture and pass on your whole family wealth, including your Intellectual, Spiritual and Human assets. I cant go into all of the details here, but well definitely talk about it when you come in for your Life and Legacy Planning Session.