What is Medicaid?

What is Medicaid?

  • Medicaid is the nation's public health insurance program for people with low income. Medicaid covers a broad array of health services and limits enrollee out-of-pocket costs.

 

What does it mean to expand Medicaid?

  • A provision in the Affordable Care Act (ACA) called for expansion of Medicaid eligibility in order to cover more low-income Americans. Under the expansion, Medicaid eligibility would be extended to adults up to age 64 with incomes up to 138% of the federal poverty level (133% plus a 5% income disregard).

 

Who is covered under Medicaid expansion?

  • Pre-ACA, Medicaid was generally never available to non-disabled adults under age 65 unless they had minor children. Under the expansion, Medicaid eligibility would be extended to adults up to age 64 with incomes up to 138% of the federal poverty level.

 

Why is Medicaid expansion good?

  • Financial Security and Opportunities for Economic Mobility. Medicaid expansion has made it easier for people to afford needed health care, studies find — reducing medical debt, problems paying bills, and evictions.

What is the new Medicaid expansion?

  • The American Rescue Plan Act (ARP) encourages states to expand their Medicaid programs to cover adults — up to age 65 — with incomes at or below 138 percent of the federal poverty level ($30,305 for a family of three in 2021)

 

How is the Medicaid expansion funded?

  • Medicaid is financed by both the federal government and the states using a formula that is based on a state's per capita income. The federal share (FMAP) varies by state from a floor of 50% to a high of 74% with exceptions for certain services or populations.

What are the disadvantages of Medicaid?

  • Lower reimbursements and reduced revenue. Every medical practice needs to make a profit to stay in business, but medical practices that have a large Medicaid patient base tend to be less profitable.

 

12 States have not adopted Medicaid expansion

  • States that have not expanded Medicaid: Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming.

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