The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update January 2016
One of the major coverage provisions of the Affordable Care Act (ACA) is the expansion of Medicaid eligibility to nearly all low-income individuals with incomes at or below 138 percent of poverty ($27,724 for a family of three in 20151). This expansion fills in historical gaps in Medicaid eligibility for adults and was envisioned as the vehicle for extending insurance coverage to low-income individuals, with premium tax credits for Marketplace coverage serving as the vehicle for covering people with moderate incomes. While the Medicaid expansion was intended to be national, the June 2012 Supreme Court ruling essentially made it optional for states.
As of January 2016, 19 states were not expanding their programs. Medicaid eligibility for adults in states not expanding their programs is quite limited: the median income limit for parents in 2016 is just 44% of poverty, or an annual income of $8,840 a year for a family of three, and in nearly all states not expanding, childless adults remain ineligible.2 Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults fall into a “coverage gap” of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits. #ACA #Obamacare #Medicaid
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The Coverage Gap: Uninsured Poor Adults in States that
Do Not Expand Medicaid – An Update
Rachel Garfield and Anthony Damico
One of the major coverage provisions of the Affordable Care Act (ACA) is the expansion of Medicaid eligibility
to nearly all low-income individuals with incomes at or below 138 percent of poverty ($27,724 for a family of
three in 20151). This expansion fills in historical gaps in Medicaid eligibility for adults and was envisioned as
the vehicle for extending insurance coverage to low-income individuals, with premium tax credits for
Marketplace coverage serving as the vehicle for covering people with moderate incomes. While the Medicaid
expansion was intended to be national, the June 2012 Supreme Court ruling essentially made it optional for
states.
As of January 2016, 19 states were not expanding their programs. Medicaid eligibility for adults in states not
expanding their programs is quite limited: the
median income limit for parents in 2016 is just
44% of poverty, or an annual income of $8,840 a
year for a family of three, and in nearly all states
not expanding, childless adults remain ineligible.2
Further, because the ACA envisioned low-income
people receiving coverage through Medicaid, it
does not provide financial assistance to people
below poverty for other coverage options. As a
result, in states that do not expand Medicaid,
many adults fall into a “coverage gap” of having
incomes above Medicaid eligibility limits but
below the lower limit for Marketplace premium
tax credits (Figure 1).
This brief presents estimates of the number of people in non-expansion states who could have been reached by
Medicaid but instead fall into the coverage gap, describes who they are, and discusses the implications of them
being left out of ACA coverage expansions. An overview of the methodology underlying the analysis can be
found in the Methods box at the end of the report, and more detail is available in the Technical Appendices
available here.
Figure 1
Gap in