OM: Medicaid Expansion Will Cover Half Of U.S. Population In January 2014

 

Medicaid Expansion Will Cover Half Of U.S. Population In January 2014

Open Minds  August 4, 2013

 

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About 45% of the United States population lives in the 23 states and the District of Columbia that are planning to expand Medicaid eligibility under the Patient Protection and Affordable Care Act of 2010 (PPACA), as of July 2013. Of all the provisions of the PPACA, the Medicaid expansion is the only provision that states have a choice in implementing, per a June 2013 decision from the U.S. Supreme Court.

 

The Medicaid expansion under PPACA expands the program to nearly all low-income, uninsured, childless, non-disabled, on-institutionalized adults. As of January 1, 2014, Americans between the ages of 18 and 64 who have incomes less than 133% of the federal poverty level (FPL), who are not pregnant and not otherwise eligible for Medicaid, will be eligible to enroll in Medicaid if they live in a state that has opted to expand eligibility beyond existing eligibility categories of children, frail elderly, blind/disabled, or caretaker adults. The individual FPL in 2013 was $11,490 in the 48 contiguous states; $14,350 in Alaska and $13,230 in Hawaii. The 2013 FPL for a family of four was $23,550 in the 48 contiguous states; $29,440 in Alaska and $27,090 in Hawaii. In the states expanding Medicaid eligibility, the only low-income, uninsured state residents who would be ineligible are undocumented immigrants, people who lack a Social Security number, and people in state custody in jails, prisons, or other institutional settings.

 

Projected Medicaid Enrollments In States Expanding Medicaid In 2014

State

Total Population from 2010 census

Estimated Expansion Population

Expansion Population As Percentage Of All Residents

Medicaid Enrollment in 2010

Estimated Total Medicaid Population in 2014

United States Total

314 million (2012 estimate)

11.5 million

4%

66 million

77.5 million

Arizona

6,392,000

32,000

1%

1,531,000

1,563,000

Arkansas

2,916,000

167,000

6%

699,000

866,000

California

37,254,000

1,415,000

4%

11,335,000

12,750,000

Colorado

5,029,000

161,000

3%

700,000

861,000

Connecticut

3,574,000

71,000

2%

712,000

783,000

Delaware

898,000

3,000

<1%

225,000

228,000

District of Columbia

602,000

15,000

2%

213,000

228,000

Hawaii

1,360,000

33,000

2%

261,000

294,000

Illinois

12,831,000

431,000

3%

2,780,000

3,211,000

Iowa

3,046,000

8,0000

3%

555,000

635,000

Kentucky

4,339,000

223,000

5%

907,000

1,130,000

Maryland

5,774,000

142,000

2%

952,000

1,094,000

Massachusetts

5,548,000

70,000

1%

1,654,000

1,724,000

Minnesota

5,304,000

103,000

2%

936,000

1,039,000

Nevada

2,701,000

127,000

5%

340,000

467,000

New Jersey

8,792,000

245,000

3%

1,026,000

1,271,000

New Mexico

2,059,000

102,000

5%

576,000

678,000

New York

19,378,000

62,000

<1%

5,570,000

5,632,000

North Dakota

673,000

14,000

2%

82,000

96,000

Oregon

3,831,000

194,000

5%

644,000

838,000

Rhode Island

1,053,000

31,000

3%

205,000

236,000

Vermont

626,000

1,000

<1%

196,000

197,000

Washington

6,725,000

237,000

4%

1,353,000

1,590,000

West Virginia

1,853,000

10,1000

5%

430,000

531,000

Sum of states expanding Medicaid

142,558,000

4,060,000

3%

33,882,000

37,942,000

 

According to an analysis by the Urban Institute, at present there are 11.5 million people in the expansion population nationwide. About four million live in the 23 states and District of Columbia, which are expanding eligibility. About 5.5 million live in the 21 states that have not enacted legislation to expand Medicaid. Another two million live in the six states that have made no formal decision as of July 9, 2013. These undecided states are Indiana, Michigan, New Hampshire, Ohio, Pennsylvania, and Tennessee.

 

For the expansion population, states will receive 100% federal funding for the first three years to support this expanded coverage, phasing down to no less than 90% federal funding in subsequent years. Medicaid matching rates will remain at the previous federal level for existing eligibility categories.

 

Additional details about the states expanding Medicaid as of January 1, 2014, are as follows:

  • Incarcerated offenders in the expansion population are not eligible to enroll in Medicaid until they are released from state custody. They are considered to be “insured” while incarcerated because the state prison or local jail is responsible for inmate health care services.
  • Low-income residents of other state-run institutions, such as institutions of mental disease or intermediate care facilities for individuals with developmental disability, are also in the expansion population, but will not be eligible to enroll in Medicaid unless they are transitioned to a community living arrangement. While living in an institution in state custody, their medical care is the responsibility of the state.
  • Under certain circumstances, hospitals will be able to determine presumptive eligibility for Medicaid for uninsured patients.

A link to the full text of “Medicaid Spending & Enrollment Detail For CBO’s May 2013 Baseline” may be found in The OPEN MINDS Circle Library at www.openminds.com/library/053113cbomedicaidbaseline.htm

A link to the full text of “June 2013 MACStats: Medicaid and CHIP Program Statistics” may be found in The OPEN MINDS Circle Library at www.openminds.com/library/061413macpacreport.htm

A link to the full text of “Understanding CBO’s Medicaid Coverage Projections Under The Affordable Care Act” may be found in The OPEN MINDS Circle Library atwww.openminds.com/library/062313cbomedicaidexpest.htm

The full text of a report on Medicaid expansion by Avalere Health “State Reform Insights, Updated July 9, 2013” is available online at www.avalerehealth.net/news/spotlight/20130709_Medicaid_Expansion.pdf (accessed August 1, 2013).

The full text of the Urban Institute’s report on Medicaid expansion “11.5 Million Poor Uninsured Americans Could Be Eligible For Medicaid If States Opt For ACA Expansion” is available online atwww.urban.org/health_policy/health_care_reform/map.cfm (accessed August 1, 2013).

The full text of a legislative analysis of Medicaid expansion initiatives by the Kaiser Family Foundation “Status Of State Action On The Medicaid Expansion Decision, As Of July 1, 2013” is available online athttp://kff.org/medicaid/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/ (accessed August 1, 2013).

OPEN MINDS also reported on the Medicaid expansion in “Health Care Reform Regs Streamline Medicaid Eligibility For State Prison Inmates.” The article is available at www.openminds.com/market-intelligence/premium/omol/2013/072213soc1.htm

For more information, contact:

  • Erica Garland, Account Supervisor, GYMR Public Relations, Avalere Health LLC, 1350 Connecticut Avenue, N.W., Suite 900, Washington, District of Columbia 20036; 202-745-5119; E-mail: egarland@gymr.com; Website: www.avalerehealth.net
  • Simona Combi, Public Affairs, Urban Institute, 2100 M Street NW, Washington, District of Columbia 20037; 202-261-5709; E-mail: SCombi@urban.org; Website: www.urban.org.
  • Rakesh Singh, Vice President of Communications, Kaiser Family Foundation, 2400 Sand Hill Road, Menlo Park, California 94025; 650-854-9400; E-mail: rsingh@kff.org; Website: www.kff.org
  • Deborah Kilroe, Associate Director, Communications, Congressional Budget Office, Second and D Streets, S.W., Ford House Office Building, 4th Floor, Washington, District of Columbia 20515-6925; 202-226-2602; E-mail: communications@cbo.gov; Website: www.cbo.gov
  • Laura Diamond, Communications Director, Medicaid and CHIP Payment and Access Commission, 1800 M Street, N.W., Suite 650 South, Washington, District of Columbia 20036; 202-350-2000; E-mail:laura.diamond@macpac.gov; Website: www.macpac.gov
  • Public Information Officer, U.S. Census Bureau, 4600 Silver Hill Road, Washington, District of Columbia 20233; 301-763-3030; E-mail: pio@census.gov; Website: www.census.gov



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