Medicaid Expansion

The Medicaid expansion in recent years has affected millions of Residents who earn a low income and could not otherwise afford health care coverage. However, not all states have undergone this change.

Medicaid expansion helps more low-income adults access lifesaving healthcare coverage, while simultaneously lowering premium rates of other private insurance purchasers. However, Medicaid expansion is not in every state. Knowing whether your state adopted the new rules can help you to determine your own eligibility for assistance.

The ACA Medicaid expansion refers to the Affordable Care Act often referred to as Obamacare. The states that have expanded Medicaid accepted the suggestions put forth in the ACA to support even more residents who are in need of health care coverage. Providing free or low-cost services to millions more helps to lower the overall health care costs in the country. More states are accepting this expansion, as statistics have proven the expansion to be effective and desirable on many levels.

What is the ACA Medicaid Expansion?

The ACA Medicaid expansion allows the Medicaid program to offer health care services to more residents who otherwise could not afford coverage. Medicaid is administered by each individual state under guidance from the federal government. Congress can pass laws related to Medicaid that must then be implemented on a state-by-state basis. At the federal level, Medicaid is run by the Centers for Medicare & Medicaid Services (CMS), which then oversees all state programs.

Under the Medicaid expansion, Affordable Care Act beneficiaries include not only families and children, but even adults without children who receive a low income according to government standards. Under the old Medicaid rules, only individuals or families who met the standards for various eligibility factors could qualify.

In states that did not expand Medicaid, those old rules still apply. Currently, 17 states have chosen not to adopt the new rules. However, three of those states are considering an expansion soon. All other states and the District of Columbia have updated their rules for eligibility for Medicaid in an effort to provide much-needed assistance to more residents that are eligible.

Related Article: Medicaid Eligibility

If your state adopted the Obamacare Medicaid expansion, then you might qualify for the program based solely on your income level. These income eligibility standards are set against what is called the federal poverty level (FPL). This means that your total income will be compared to the poverty level of income as determined by the government, which will be calculated as a percentage to determine your qualifications. As a baseline, if your income is 133 percent of the federal poverty level (FPL) and your state has accepted the Medicaid expansion rules, then you should automatically qualify for Medicaid coverage.

Medicaid Expansion States

Finding out which states expanded Medicaid can help you to determine the basic eligibility standards you might encounter when you apply for assistance. The states that expanded Medicaid so far include the following:

  1. Alaska
  2. Arizona
  3. Arkansas
  4. California
  5. Colorado
  6. Connecticut
  7. Delaware
  8. District of Columbia
  9. Hawaii
  10. Illinois
  11. Indiana
  12. Iowa
  13. Kentucky
  14. Louisiana
  15. Maine
  16. Maryland
  17. Massachusetts
  18. Michigan
  19. Minnesota
  20. Montana
  21. Nevada
  22. New Hampshire
  23. New Jersey
  24. New Mexico
  25. New York
  26. North Dakota
  27. Ohio
  28. Oregon
  29. Pennsylvania
  30. Rhode Island
  31. Vermont
  32. Virginia
  33. Washington
  34. West Virginia

All of those states that accepted the Medicaid expansion have changed their eligibility criteria to be solely based on income. You will still have to provide details about your household and family status, plus other identifying information, but your income alone could qualify you to receive assistance. If you earn less than 133 percent of the FPL, you should apply. Because of an additional five percent buffer, you can actually earn up to 138 percent of the FPL. Note that some states may deviate from the FPL and have different income limits.

States That Did Not Expand Medicaid

The Medicaid program expansion has not been adopted by all states yet. If you live in one of the states without the Medicaid expansion, then your eligibility criteria will remain complicated. That means that your income alone will not determine your qualification to receive assistance. You will have to meet all of the factors set by your state Medicaid agency to prove your need for assistance.

There are also three states considering the Medicaid expansion currently, which could be adopted in the near future. Those states are Idaho, Nebraska and Utah. States that are not listed here or in the list above have not adopted the expanded regulations. If you live in one of those states that has not expanded coverage, you can still learn how to apply for affordable health insurance. You can also contact your political representatives to encourage the expansion to be implemented locally.

In states that did not accept the Medicaid expansion, there is an exemption available to those who do not qualify for Medicaid to avoid paying the health care fee. Under the Affordable Care Act, everyone is required to have health care coverage and those who do not maintain coverage have to pay a fee when filing taxes. If you do not have any coverage and you live in a state that has not expanded Medicaid but you would qualify if it had, then you do not need to pay the fee. You can get this exemption by applying for coverage in the national healthcare online marketplace or just apply specifically for the exemption.

Is Medicaid Expanded?

Expanded Medicaid is both a reality and a dream, depending on the state where you live. Many states have adopted an expansion of Medicaid, but some continue to refuse the new rules and regulations. Although Medicaid is a federal program, it is actually operated on a state level so each state can determine its own rules. Until each state expands its own Medicaid program, many residents will continue to suffer from a lack of healthcare options.

States that did not expand Medicaid continue to debate the expansion regulations, so you can always contact your representatives to encourage the new rules to be adopted in your state. You also might still qualify for Medicaid even under the old rules, so be sure to contact your local Medicaid offices for details and application assistance.

Related Article: Medicaid Related Programs

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