The Affordable Care Act and Medicaid

What is Medicaid?

Medicaid is a health insurance program for certain people with low incomes. These people are:

The federal government and each state pay for the costs of Medicaid. The Medicaid program in each state is slightly different. Each state decides what services its Medicaid program will cover, and who qualifies for Medicaid.

What is Medicaid Expansion?

Before the ACA, states had different rules about who qualified for Medicaid. It depended on whether you had children, if you had a disability, whether you were male or female, your age, and how much money you made. The ACA makes it easier to qualify for Medicaid. This is called Medicaid expansion.

Medicaid expansion increases the number of people who can get Medicaid. Medicaid expansion allows everyone younger than 65 to qualify for Medicaid if they make less than 138% of the federal poverty level (about $16,242 a year for a single person and $33,465 a year for a family of four in 2016). Because of Medicaid expansion, many people who were not allowed to apply for Medicaid can now qualify (including single men).

Are all of the States Expanding Medicaid?

In June 2012, the Supreme Court ruled that states did not have to expand Medicaid. They said each state could decide whether or not to expand their Medicaid program.

Some states are expanding their Medicaid programs, and other states are against Medicaid expansion. To find out if your state plans to expand Medicaid, go to: http://familiesusa.org/product/50-state-look-medicaid-expansion

How Do I Apply for Medicaid?

You can apply for Medicaid all year long. There is no limited enrollment period for Medicaid.

You can apply for Medicaid by choosing your state from the drop down menu here.

What if My State did not Expand Medicaid?

If your state did not expand Medicaid, you have several options depending on your income:

  1. If you would have qualified for Medicaid under the expansion, you may not have to pay the insurance tax. This is called a Health Insurance Exemption. You can apply for an exemption by filling out an exemption form from: https://www.healthcare.gov/fees-exemptions/apply-for-exemption/

    If you apply for an exemption, you will qualify for catastrophic insurance. To read more about catastrophic insurance, go to: http://obamacarefacts.com/health-insurance/catastrophic-plans/

  2. You may qualify for subsidies in the Health Insurance Marketplace if your income is between 100%-400% of the federal poverty level ($11,770-$47,080 per year for a single person and $24,250-$97,000 per year for a family of four in 2016). If you buy your insurance through the Health Insurance Marketplace, you can get help to pay for your insurance (called a subsidy). To find out more about the Health Insurance Marketplace, click here.

  3. Even if your state did not expand Medicaid, you may still qualify for Medicaid. If you make less than 100% of the federal poverty level ($11,770 per year for a single person and $24,250 per year for a family of four in 2016), you should still apply for Medicaid to see if you qualify. You can apply for Medicaid by choosing your state from the drop down menu here.

What is the Medicaid Coverage Gap?

Qualifying for Medicaid is difficult in many states that did not expand their Medicaid programs. In most of these states, you must be a parent, and you must make less than 50% of the federal poverty level to qualify ($12,125 per year for a family of four in 2016).

Because Medicaid expansion was intended to be national, the ACA does not provide any help for people who make between 50%-100% of the federal poverty level ($5,885-$11,770 per year for a single person and $12,125-$24,250 per year for a family of four in 2016). Medicaid expansion was supposed to help people in this group. As a result, there are large gaps in insurance coverage for some adults. This is often called the Medicaid Coverage Gap.

Gap in Coverage Figure

Who Pays for Medicaid Expansion?

Medicaid expansion means that lots of new people will be able to get Medicaid. This also means that more money will be needed to pay for Medicaid.

If your state expands its Medicaid program, the federal government will pay the costs of all the new people who get Medicaid. Beginning in 2017, the federal government will start to pay less of these costs, and the states will start to pay more. By 2020, the federal government will pay 90% of the costs of Medicaid expansion.

Where Can I Get More Information?

To find information about your state’s Medicaid program, use the menu at the bottom of the page on this government website: https://www.healthcare.gov/do-i-qualify-for-medicaid

Families USA has an entire Expansion Center dedicated to Medicaid expansion: http://www.familiesusa.org/issues/medicaid/expansion-center/

A short, easy to understand video about Medicaid expansion by the Robert Wood Johnson Foundation: https://www.youtube.com/watch?v=fGEU0a75tiw

A frequently updated table by the Kaiser Family Foundation on the status of states’ decision on Medicaid expansion: http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/

The Kaiser Family Foundation has a large section of the website focused on Medicaid and Medicaid expansion: http://kff.org/medicaid/