Under the Affordable Care Act states across America were given the option to expand their Medicaid/ Medi-Cal programs to help ensure their low-income residents were able to get free or reduced cost health coverage. Most states expanded their Medicaid programs but some, more conservative states did not. Here on Carelifornia, we talk a lot about Covered California and the Individual Healthcare health exchanges and there are around 8 1/2 million Americans who are utilizing these health exchanges to get help paying for their private health insurance. But one program we have not talked about much is the Medicaid program. Medicaid is a health insurance program for people, seniors, children, disabled people who have income low enough to qualify. Medicaid or Medi-Cal, as it is called in California, is a massive program that covered 74 Million people in 2019 and the number is only growing with the jump in unemployment and so many people loosing their jobs and insurance through their work. Under the Affordable Care act, Medicaid was allowed to raise its income requirements allowing millions of more people to get enrolled and get the healthcare they need. Without the Expanded Medicaid programs states have left some of their low-income residents stuck in a gap where they are too rich for Medicaid and too poor for the exchanges. Today we are going to discuss which states have expanded their Medicaid programs, which states have not, and what this means for low income Americans struggling with healthcare in this time of the pandemic. Please don’t forget to like and subscribe. 

What is Medicaid

• The Medicaid program is a safety net health insurance program that is funded in part by the federal government and in part by states
• Although the federal government funds the majority of costs It allows people with low income to get free or very low-cost health services based on their household size and income. 
• It is full coverage, and covers most health service that would be covered under a private health insurance of Medicare. 

It covers things like doctors’ visits, prescription drug cost, hospitalization costs and lab test and much more 

• It is the main program that provides health insurance coverage for low income folks across American and in some states has income limits that are quite generous 
• The benefits can be utilized year over year or just temporarily as long as a person stays within the income limits 

 How was it changed by Obamacare 

• Under the affordable care act or Obamacare, the types of benefits, eligibility requirements, and funding to states Were dramatically increased, to try to encourage states to expand their Medicaid programs
• At first the Federal government for a few years would cover nearly 100% of the cost of the expansions
• After a few years the ACA would start to reduce the funding from the federal government And expect states, to take over some of the cost for the newly expanded services
• The federal government would still pay around 90% of the cost for services and states would end up paying 10% or less

Raising the income limit 

• One of the biggest things that the ACA Medicaid Expansion did allowed states to move the income requirement from 100% of the federal poverty level where it traditionally had been , to 138% of the federal poverty level where the income requirement for ACA health Exchanges coverage began
• For a household of 4 in 2020 that would mean the difference of $26,200 a year to $36,157 which is $9957
• This  meant households could make a lot more money and still be able to get healthcare that was low cost or free, better services and save that money for other costs of daily living which would  improve their standard of living immensely 

 Which states participated 

• Programs like this seem like a no-brainer for states to participate, especially considering the Federal gov was going to fund the vast majority of the cost to improve the lives of the poorest households in any states who participated 
• 36 states jumped on the opportunity, state like – California, New York and Colorado, but also some red states , Arizona , Kentucky , Louisiana and recently Nebraska
• Some of the most conservative states have still not participated in the expansion
• Which has cause millions of people whose income is above 100% FPL but below 138% of the FPL to be stuck a limbo
• In the states that have not expanded Medicaid, in order to qualify for free health care through Medicaid, families and households have to make less than 100% of the FPL,  but to get reduced cost health insurance through the ACA exchanges they would have to have income above 138% of the FPL
• So there is a gap between 100% FPL for Medicaid eligibility and 138% for health exchange eligibility 
• This is because the Exchanges were designed with the anticipation that states would take the money from the federal government to expand and increase the income eligibility for their Medicaid programs from 100% to 138% FPL . 
• This would mean that regardless of someone’s income they would be either eligible for Medicaid if they are below 138%, or for Obamacare if they are above
• In states who decided against expanding benefits their residents, who have incomes between 100% and 138%, are stuck in a healthcare purgatory 
• Where they make too much money for Medicaid but too little money Obamacare. 

 Which states have still not expanded Medicaid 

• There are still 14 states in 2020 who have this hole in their healthcare 
• These states are Wyoming, South Dakota, Wisconsin, Kansas, Missouri, Oklahoma, Texas , Tennessee , North and South Carolina, Mississippi, Alabama , Georgia, and Florida 
• Recently Nebraska had been on this list but as of 2020 they have decided to expand there Medicaid benefits starting at the beginning of this year open enrollment period for the health exchanges in October 

 Conclusion 

• Overall, its apparent that some states faced with an opportunity to improve the lives of their residents for pennies on the dollar, being mostly subsidized by the federal governments
• Have decided to decline the offers for obviously political reasons. 
• AS time goes by and some of the animosity against the aca fades we can see that some states like Nebraska are finally making the right decision to help there residents
• Good job Nebraska

Thank you so much for watching, if you have questions about your Medicare or Medicare health plan options please feel free to contact us and we can make a new post or video to cover your questions. We here at California know health insurance weather it is private health insurance, Medicare, Medicaid / Medi-Cal, Medigap or health insurance for your small business. It can be very confusing coming from your work insurance and trying to look at options on the private market or turning 65 and trying to figure out which Medicare option is best for you. That is exactly what we can do, we can walk you through your options and help you find the plans that fits your needs and your budget.