April is Medicaid Awareness month, which is a good thing because who won’t need a quick medical check-in to treat the sting from our upcoming tax bill? (Kidding, kidding… I’ll show myself out!)
But in reality, if you don’t have a private insurance plan (provided by your employer or one you purchased on your own) or if you don’t have an insurance plan from the Affordable Care Act’s marketplace, then Medicaid is your next-best way of getting that doctor’s appointment.
One provision from the 2010 Patient Protection and Affordable Care Act (also known as the ACA and Obamacare) called for expanding Medicaid eligibility to more people. The expansion was introduced to help even more low-income adults than ever get health care.
Qualifying for Medicaid
To qualify for Medicaid based on your income, you’d have to earn less than 138% of the federal poverty level. You’d also have to live in a state that expanded the program. For 2022, that’s roughly under $18,754 per year for individuals and $25,268 for a family of two. (Remember, this is the federal poverty level — not state.) The amount is the same whether you live in Maine, Nevada or Texas. Of course, it costs more money to live in some parts of the country, which is why certain states have higher poverty numbers than others.
Federal Poverty Level & Medicaid
However, while the federal poverty level is the same across the country, the number of people who qualify for Medicaid often changes from year to year. That’s because the numbers depend on typical factors like inflation and even state legislation. And then there are unique factors, like the pandemic.
Here is a federal poverty level calculator (conveniently called the FPL Calculator). It can help you determine whether you may qualify for Medicaid (again, your state can still say you earn too much even if you do show earnings in the poverty range). This tool will also help you determine if you qualify for other assistance, like tax subsidies and your state’s Supplemental Nutrition Assistance Program (SNAP) for kids.
The Affordable Care Act and Medicaid Expansion is 12 Years Old
Here’s a very brief primer on Medicaid. If you’re familiar with the program (and later, the expansion), then you know it was groundbreaking legislation when it was introduced in the 1960s. We’ve published articles in the past about why so many Americans are still locked out of the program and why it’s difficult to change laws in this country. For example, see “History of Health Insurance in the U.S.” While it’s been about 12 years since the ACA and Medicaid expansion was passed, a handful of states still do not offer Medicaid to all “qualified” residents.
Medicare was first passed in 1965 under President Lyndon Johnson.
In 2019, it was estimated that 2.2 million uninsured adults were stuck in what’s known as the Medicaid expansion gap. This means that their income was above Medicaid eligibility but below the lower limit to qualify for Marketplace premium tax credits.
Passing Medicaid Legislation
The ACA, including the Medicaid expansion, is a perfect example of how certain laws seem to crawl through the House and Senate. The same thing happens with state laws, too.
As far as federal Medicaid expansion is concerned, the law did get the votes it needed to pass back in 2010. But states were not required to implement it. Over the years, some states that did not opt-in at first did, subsequently, give citizens the chance to vote for it. For example, the Washington Post reported in 2018 that three states voted to expand Medicaid: Idaho, Nebraska and Utah. There were also states that put the program on the ballot, got enough votes to pass it, but still chose to not expand the program, such as Missouri. Legislators there said the state couldn’t fund the expansion, according to a recent article in U.S. News & World Report.
So if your state is still on the non-participation list in 2022, there may still be ways to get the expansion passed. It all depends on how your state enacts legislation and, ultimately, who is in charge.
Medicaid Awareness Month is in April
Since it’s Medicaid Awareness Month, and the program has been called a “lifeline for millions of Americans,” we wanted to go through some of the ways it helps many of our country’s neediest citizens.
How Medicaid Works
Here’s a quick rundown of how Medicaid works and some of the benefits it provides.
- Medicaid (including CHIP) covers 1 in 4 Americans. It’s designed to provide long-term care to the neediest people. It also provides short-term care to individuals and families in times of crisis.
- It’s designed as a “federal-state” partnership. While there are federal standards in place for running the program, states have a lot of say in how the program is actually implemented. Individual states determine who qualifies for coverage, how health care is delivered, and the ways hospitals and physicians are paid. For example, a lot of people think Medicaid is just like insurance offered to government workers and those in the armed forces. But in actuality, most enrollees in Medicaid get care through private managed care plans, according to the Kaiser Family Foundation (or KFF).
- The Affordable Care Act provides 90% federal matching funds for the expansion population with additional funds available through the American Rescue Plan Act to incentivize non-expansion states.
- Medicaid represents $1 out of every $6 spent on health care in the U.S.
- Medicaid covers about half of all births in the U.S.
- In most states, pregnant women and children can qualify with incomes exceeding 138% FPL.
- In some states, even higher-income families can enroll children in Medicaid. Examples would be foster children and children with significant disabilities that would be too expensive for the family to cover without assistance.
- Children on Medicaid receive more services than adults, such as vision and dental care.
- 62% of seniors living in nursing homes are covered by Medicaid.
- For the elderly and disabled, Medicaid covers long-term nursing home or at-home care (for those who qualify).
For more details about Medicaid and other government health programs, such as the CHIP and military health programs, check out chapter 7 of the book, Decoding Health Insurance and the Alternatives: Options, Issues, and Tips for Saving Money.
What Medicaid Covers
Since Medicaid is federal-state run, it’s difficult to list exactly what services and treatments it covers. This is how enrollees can see what benefits they’re eligible for:
- Go to Healthcare.gov/lower-costs/.
- Fill out a short form with questions like “What state do you live in?” and “How many people live in your household?”
Depending on your answers, you’re given your state’s health care marketplace website to go to for more information about the benefits you qualify for. Others can get more information about the Medicaid expansion at Healthcare.gov.
States That Offer the Medicaid Expansion
This map shows which states have adopted and implemented the Medicaid expansion. They’re depicted in dark blue. The states in orange do not offer Medicaid based on income alone. But no matter where you live, citizens can go to Healthcare.gov to apply for medical services. One of the biggest reasons Medicaid benefits differ from state-to-state is because we have a long tradition in this country of letting states run programs in ways best suited for their needs. It makes sense when you look closely at the data. Some areas of the country have higher rates of type 2 diabetes, for example. So it doesn’t make sense for a state with low incidence of type 2 to invest the same amount of money in medical services and care.
Why Medicaid is Important
Medicaid is the primary health insurance program for Americans who earn too little to purchase a healthcare plan through the ACA Marketplace. It comes out to about 65 million Americans with diseases and disabilities like cancer, diabetes and autism.
One of the biggest benefits, though, is that Medicaid has helped millions of families avoid going into bankruptcy and losing their entire savings to care for a loved one’s medical problems. The Journal of American Medical Association (JAMA) published a study based on the country’s largest dataset of medical debt. This study revealed medical debt as the No. 1 source of debt collections, with states that did not expand Medicaid hit the hardest.
Read Decoding Health Insurance
To better understand health insurance and the U.S. health care system, check out Decoding Health Insurance and the Alternatives: Options, Issues, and Tips for Saving Money. You’ll find easy-to-read information, plus tips for buying health insurance and saving money on health care.
Check out our Partners Page for a look at some of the help you can find in the industry.