Medicaid Financing for the Uninsured Under the Affordable Care Act
Today, for adults without dependent children, no matter how poor they are, they are not eligible for Medicaid. This gap in coverage is eliminated by the Affordable Care Act (ACA). The federal government is offering to pay 100% of the costs for the new category of Medicaid clients through 2016 (phased down to 90% by 2020).
The federal government, advocates and lawyers nationwide continue to debate the impact of the Supreme Court decision with respect to Medicaid. However, it is clear that in Illinois, the Illinois Public Aid Code and administrative rules delineate key aspects of Medicaid eligibility and services (for Medicaid and SCHIP – or All Kids). Therefore, to provide services to this “new Medicaid” group, General Assembly authorization and rule-making will be required.
Issues for consideration:
Under the Affordable Care Act, the “new Medicaid” clients will be adults 19- 64 years of age, who will qualify on the basis of income – 133% of federal poverty level. (Please note: the federally required income level is actually 138% of federal poverty level, as there is a 5% universal income disregard, and this higher number will have to be included in any Illinois statute or rule.)
These “new Medicaid” clients will be low-income adults without dependent children, who cannot fit into one of the categories currently required for adults. Current categories are seniors, persons with disabilities, parents/caretakers of dependent children, or pregnant women.
In Illinois, about 200,000 “new Medicaid” clients are expected to enroll in 2014, with another 143,000 by 2017. These numbers do not include those “old Medicaid” populations of adults and children who would be eligible under current rules, but who have not previously enrolled (estimated 170,000 by 2017). Neither category of these additional enrollees would be allowed to purchase health insurance, even with tax subsidies, on the Health Insurance Exchange.
In addition, states must delineate a Benchmark Medicaid Plan for “new Medicaid” clients. The Benchmark Medicaid Plan may be same as the full service package currently available to Medicaid clients, or something different.
Review these briefing documents: