Obamacare Medicaid

Obamacare and Medicaid

The Affordable Care Act (Obamacare) expanded the income eligibility rules for Medicaid in many, but not all, states. Given the variability in Medicaid eligibility requirements, many consumers are confused.

Medicare Overview

Medicaid is a state-administered health insurance program primarily targeted at low-income citizens and other groups. The program itself receives funding both from the state government and the federal government. 60 million Americans are covered through the Medicaid program and CHIP (Children’s Health Insurance Program).

Medicaid includes common health insurance benefits such as:

  • Ambulatory care (e.g. doctor visits)
  • Hospitalization services
  • Emergency care
  • Prescription drug coverage

Some people are simultaneously enrolled in Medicaid, due to their income level, and Medicare, due to their age. These individuals are known as dual eligible and can enjoy reduced out-of-pocket costs on prescription drugs.

Medicaid Eligibility

Historically, eligibility for the Medicaid program had considered numerous factors across different states from income to assets and pregnancy status. Alongside income, there are other eligibility criteria that are used in determining eligibility. To be eligible for Medicaid, individuals must satisfy federal and state requirements regarding residency, immigration status, and provide documentation of U.S. citizenship. Coverage may be granted retroactively for up to three months prior to the actual month of Medicaid application (assuming the applicant would have been eligible during this period). Medicaid coverage generally terminates at the end of the month in which a person no longer satisfies the state and federal Medicaid eligibility requirements.

Medicaid Expansion

Obamacare provides states with the option of additional federal Medicaid funding to expand their Medicaid programs to cover adults (under age 65) who make up to 133% of the federal poverty level. The government notes that due to the way income is calculated, the income eligibility is effectively 138% of the federal poverty level. However, it should be noted that not every state has expanded its income eligibility for Medicaid.

Supreme Court Ruling

Originally the Affordable Care Act (a.k.a. Obamacare) mandated the expansion of Medicaid eligibility across all states. Several states legally fought this mandate among other issues. In 2012, the Supreme Court decided the case and found the mandated Medicaid expansion of the Affordable Care Act unconstitutionally coercive with respect to the states. Consequently, the expansion of Medicaid eligibility was left to the discretion of each state.

Medicaid Expansion States

The information below documents the expansion status for each state:

Alabama
No expansion of Medicaid income eligibility.

Alaska
No expansion of Medicaid income eligibility.

Arizona
Starting in 2014, Arizona households with incomes up to 133% of the federal poverty level are eligible for Medicaid.

Arkansas
Arkansas expanded its Medicaid eligibility standards to include households with incomes up to 133% of the federal poverty level for Medicaid eligibility.

California
Starting in 2014, Arkansas households with incomes up to 133% of the federal poverty level are eligible for Medicaid.

Colorado
Colorado expanded its Medicaid eligibility standards to include households with incomes up to 133% of the federal poverty level for Medicaid eligibility.

Connecticut
Starting in 2014, Connecticut households with incomes up to 133% of the federal poverty level are eligible for Medicaid.

Delaware
Delaware expanded its Medicaid eligibility standards to include households with incomes up to 133% of the federal poverty level for Medicaid eligibility.

District of Columbia
Starting in 2014, D.C. households with incomes up to 133% of the federal poverty level are eligible for Medicaid.

Florida
No expansion of Medicaid income eligibility.

Georgia
No expansion of Medicaid income eligibility.

Hawaii
Hawaii expanded its Medicaid eligibility standards to include households with incomes up to 133% of the federal poverty level for Medicaid eligibility.

Idaho
No expansion of Medicaid income eligibility.

Illinois
Starting in 2014, Illinois households with incomes up to 133% of the federal poverty level are eligible for Medicaid.

Indiana
No expansion of Medicaid income eligibility.

Iowa
Iowa expanded its Medicaid eligibility standards to include households with incomes up to 133% of the federal poverty level for Medicaid eligibility.

Kansas
No expansion of Medicaid income eligibility.

Kentucky
Starting in 2014, Kentucky households with incomes up to 133% of the federal poverty level are eligible for Medicaid.

Louisiana
No expansion of Medicaid income eligibility.

Maine
No expansion of Medicaid income eligibility.

Maryland
Maryland expanded its Medicaid eligibility standards to include households with incomes up to 133% of the federal poverty level for Medicaid eligibility.

Massachusetts
Starting in 2014, Massachusetts households with incomes up to 133% of the federal poverty level are eligible for Medicaid.

Michigan
Michigan expanded its Medicaid eligibility standards to include households with incomes up to 133% of the federal poverty level for Medicaid eligibility.

Minnesota
Starting in 2014, Minnesota households with incomes up to 133% of the federal poverty level are eligible for Medicaid.

Mississippi
No expansion of Medicaid income eligibility.

Missouri
No expansion of Medicaid income eligibility.

Montana
No expansion of Medicaid income eligibility.

Nebraska
No expansion of Medicaid income eligibility.

Nevada
Nevada expanded its Medicaid eligibility standards to include households with incomes up to 133% of the federal poverty level for Medicaid eligibility.

New Hampshire
No expansion of Medicaid income eligibility.

New Jersey
Starting in 2014, New Jersey households with incomes up to 133% of the federal poverty level are eligible for Medicaid.

New Mexico
New Mexico expanded its Medicaid eligibility standards to include households with incomes up to 133% of the federal poverty level for Medicaid eligibility.

New York
Starting in 2014, New York households with incomes up to 133% of the federal poverty level are eligible for Medicaid.

North Carolina
No expansion of Medicaid income eligibility.

North Dakota
North Dakota expanded its Medicaid eligibility standards to include households with incomes up to 133% of the federal poverty level for Medicaid eligibility.

Ohio
Starting in 2014, Ohio households with incomes up to 133% of the federal poverty level are eligible for Medicaid.

Oklahoma
No expansion of Medicaid income eligibility.

Oregon
Oregon expanded its Medicaid eligibility standards to include households with incomes up to 133% of the federal poverty level for Medicaid eligibility.

Pennsylvania
No expansion of Medicaid income eligibility.

Rhode Island
Starting in 2014, Rhode Island households with incomes up to 133% of the federal poverty level are eligible for Medicaid.

South Carolina
No expansion of Medicaid income eligibility.

South Dakota
No expansion of Medicaid income eligibility.

Tennessee
No expansion of Medicaid income eligibility.

Texas
No expansion of Medicaid income eligibility.

Utah
No expansion of Medicaid income eligibility.

Vermont
Vermont expanded its Medicaid eligibility standards to include households with incomes up to 133% of the federal poverty level for Medicaid eligibility.

Virginia
No expansion of Medicaid income eligibility.

Washington
Starting in 2014, Washington households with incomes up to 133% of the federal poverty level are eligible for Medicaid.

West Virginia
West Virginia expanded its Medicaid eligibility standards to include households with incomes up to 133% of the federal poverty level for Medicaid eligibility.

Wisconsin
No expansion of Medicaid income eligibility.

Wyoming
No expansion of Medicaid income eligibility.

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