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Health Reform 2.0: Governors Pushing Back on Medicaid Expansion
Date:9/21/2012

rules vary widely from one state to another. In most states, low-income, non-disabled adults who aren't pregnant or don't have dependent children can't qualify for Medicaid coverage. Few states cover non-disabled parents at or above 100 percent of the federal poverty level -- currently $19,090 for a family of three.

The Affordable Care Act set out to close health insurance gaps by establishing a new minimum standard for Medicaid coverage. Effective January 2014, people under age 65 -- who aren't already Medicaid-eligible -- with incomes below 133 percent of the federal poverty level would be covered.

Based on 2012 guidelines, an individual making up to $15,415, or a family of four earning as much as $31,809, could meet that income threshold.

If every state participated in the expansion, 15.1 million adults who are not currently Medicaid-eligible could get coverage, according to the Urban Institute, a liberal-leaning think tank on social, economic and governance issues.

Allowing states to bow out of the expansion alters the equation.

Congressional Budget Office Says Fewer Will Be Insured

The Congressional Budget Office now estimates that 6 million fewer people will be enrolled in Medicaid by 2022 than the 15 million previously expected under the Affordable Care Act. Three million of those people will have incomes high enough to receive federal subsidies to purchase coverage through one of the new health insurance exchanges created under the law. But the remaining 3 million will not qualify for those subsidies and will remain uninsured.

Experts say a number of factors are playing into states' decision to participate or not.

"We acknowledge that the decision will be a complex one," involving a combination of political, financial, ideological and policy factors, said Matt Salo, executive director of the National Association of Medicaid Directors, a bipartisan organization representing Medicaid directors in th
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