Let’s Talk Medicaid

There has been a lot of talk about the benefits afforded to the 48 million un-insured/under-insured Americans under the Patient Protection and Affordable Care Act (PPACA, ACA, Obamacare).  But one area we haven’t really touched on in these blogs is Medicaid.  Don’t be confused between Medicaid and Medicare.  MediCAID is a government funded /state-run program that provides free or low-cost health insurance to low-income individuals, families, and children. MediCARE is health insurance primarily for individuals 65 years of age and older, some people under 65 with certain disabilities, and all those with end-stage renal disease.

Medicaid and the Children’s Health Insurance Program (CHIP) currently provide health coverage to nearly 60 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities primarily based on income.  For many eligibility groups, income is calculated in relation to a percentage of the Federal Poverty Level (FPL).  For example, in 2013, 100% of the FPL for an individual is $11,490 and for a family of four is $23,550 (excluding Alaska and Hawaii).

The ACA was designed to expand Medicaid coverage under the eligibility enrollment system slated to go into effect January 1, 2014.  Under the ACA, the national Medicaid minimum eligibility level was raised to 133% of the FPL ($15,281.70 for an individual and $31,321.50 for a family of four).  This 33% rise would expand Medicaid coverage to approximately 16 million Americans who are currently un-insured/under-insured by 2019.  (Note, other non-financial criteria are used in determining Medicaid eligibility as well.)

Under the AC A, state agencies will use a single, streamlined application to determine eligibility for enrollment into Qualified Health Plans (QHPs) and for insurance affordability programs including advance payments of the premium tax credit, cost-sharing reductions, Medicaid, and CHIP.  So, to find out if you qualify for Medicaid or CHIP, you will go through the Federally Facilitated Exchange (FFE)/or state-run exchange portal and complete the on-line application.  A review of your application will determine what health insurance assistance you are then eligible for.

But many states, including Florida, Virginia, and Texas, are still fighting the ACA requirements and opting out of expanding their state’s Medicaid system even with the ‘carrot’ of additional financial assistance from the federal government (approximately 95% of the total cost of the expansion).  Their argument is two-fold:  1. Expansion will over-stress an already maxed-out, crumbling system, and 2. Congress is unconstitutionally coercing states into expanding their Medicaid programs by threatening the loss of federal funds if they don’t participate; in essence, holding their feet to the fire until they cooperate.

The Affordable Care Act has been a conflict-ridden, finger-pointing, argumentative law since its infancy and ultimate passing in 2010.  As the open enrollment period draws ever closer, the ACA requirements continues to pit State governors, Healthcare advocates, Congressional representatives, and even the Supreme Court against each other.  Needless to say, the ACA has been one of the most divisive laws to have passed in years.   So, will it be a train wreck waiting to happen or blue skies for clear sailing?  Who knows at this point but I definitely see no end in sight to the fight.

No Comments

Comments are closed.

Call Now Button