The Affordable Care Act (ACA) sought a major expansion of Medicaid, the federal-state program providing health care for the poor, aiming for a new national standard thatwould have extended eligibility to individuals with incomes up to 133 percent of the federal poverty level (an amount equal to $14,484 for a single person in the year 2011) by putting current federal matching funds at risk.
While the Supreme Court upheld the ACA, it set limits on the Medicaid expansion provision. States will not be required to participate in the expansion and do not risk their status quo federal funding by opting out. The ruling dramatically undermined a central component of the law -- more than half of the increase in the insured population was due to the Medicaid expansion, according to the Congressional Budget Office.
Starting in 2014, states that opt into this provision will make their residents under age 65 Medicaid-eligible if they have incomes at or below 133 percent of the federal poverty level ($14,484 for an individual or $29,726 for a family of four). For the first three years of the policy (2014-2016), the federal government will pay 100 percent of the costs of the expansion, and in subsequent years, it will gradually lower its share to 90 percent of costs.
This new standard would have added 24 million people to Medicaid, a major increase, but now the number of new enrollees is unknown. The Medicaid program already covers about 60 million people, including 30 million children, 15 million adults and 8 million people with disabilities.
“[With the ACA], the federal government sets minimum eligibility levels for coverage and then states have the option to expand eligibility to higher incomes,” according to the Kaiser Family Foundation. “Currently, 47 states set the Medicaid/CHIP (Child Health Improvement Program) income-eligibility level for children at or above 200 percent of the federal poverty level, but Medicaid coverage for parents is more limited with 39 states setting levels below 133 percent of the federal poverty level. Prior to reform, states generally could not cover non-disabled adults without dependent children under Medicaid.”
RELATED FAQS What Does the Affordable Care Act Do With Regards to Dual Eligibles?
Who Are Dual Eligibles?
How is Medicaid Financed?
