Medicaid Eligibility and Expanded Medicaid
(6/23/21)- More than 80 million people have health-care coverage through Medicaid and the Children’s Health Insurance Program according to the latest data from the Centers for Medicare and Medicaid Services(CMS).
Between February 2020 and January 2021almost 9.9 million people enrolled in the two programs. This represented a 13.9% increase over the same prior period.
About 38.3 million children were in both programs.
(3/18/21)-Under the terms of the newly passed American Rescue Plan all states will be allowed to extend Medicaid coverage for a full year, instead of the current 60 days after giving birth for low income women. The federal government will pay for this program, and it therefore will cover the more than 40 percent of the births each year in this country who are on public health programs.
The United States has the highest rate of maternal deaths of any place in the industrialized world. A third of those deaths occur after the women give birth.
(2/17/20)= The Medicaid program now covers over 71 million people, or more than one in five Americans, according to government statistics.
A three-judge panel of the United States Court of Appeals for the District of Columbia Circuit found that the Arkansas’ approval of a work requirement by the health and human services secretary Alex M. Azar was “arbitrary and capricious” because it did not address how the program would promote the objectives of Medicaid to provide health care coverage to the poor.
(1/22/20)- New York State is facing a $6.1 billion deficit for its fiscal year, which starts on April 1, 2020. About $4 billion of the shortfall comes from cost overruns in its Medicaid program, which covers more than 6 million New Yorkers.
The federal government pays for about half the cost of the state’s $80 billion Medicaid coverage. The state then splits the rest of the cost with its 58 counties, Those counties paid $7.6 billion in 2019, including $5.4 billion from New York City, according to the New York State Association of Counties.
In 2013, the state capped the size of the county contributions, but it is projected to add $1.3 billion to costs for the state during its upcoming fiscal year.
(11/9/18)- Voters in
3 states, Idaho, Nebraska and Utah, approved ballot measures to expand Medicaid
programs to its residents. The fourth state that had the measure on its ballots
to gain coverage of health insurance under the Affordable Care Act defeated the
measure, since it provided for increased tobacco taxes to help pay for the
state’s cost for the program.
in the governors’ races helped improve the chances of Kansas and Wisconsin, and
all but ensured it in Maine, which we wrote about in our item dated 6/6/18
below, to join the program.
About 800,00 people
could be added to the number of residents enrolled in expanded Medicaid,
through the 37 states and the District of Columbia that would be covered.
Enrollment in the program has already grown by at least 15.6 million, or 28
percent, since 2013, the year before the health law’s main provision took
Residents of four states will be voting on proposals at the upcoming November 6
election, whether or not to join the 33 states and District of Columbia that
presently have Expanded Medicaid programs under the Affordable Care Act
Two other states,
Kansas and Florida are also considering joining the program.
The four states are
Nebraska, Idaho, Montana and Utah that could possibly add 400,000 people and
about $1.6 billion in funding. The imitative in Montana is opposed by the
tobacco industry, since the state portion of the cost would be paid for by a
tax on tobacco products.
government pays for 93% of the cost for new enrollees in 2019, dropping to 90%
in 2020 and beyond.
Michaela Murphy of the Maine Superior C urt ordered
Republican Governor Paul LePage’s administration to submit a “state plan
amendment to update the terms of its expanded Medicaid program to the federal
government by June 11th.It is now over 7 months since the state’s
resident voted in favor of the expanded plan.
sued the governor in April, after he missed the deadline for submitting a plan
to the federal government. The plan is to go into effect by July 2 for the
newly eligible beneficiaries.
is about to become the 32nd state with an expanded Medicaid program
under the terms of the Affordable Care Act. The state’s General Assembly passed
the legislation, and Democratic Governor Ralph Northam indicated that he would
sign the bill
expanded Medicaid in Utah have obtained enough signatures on their petition to
get the initiative placed on the ballot in November. Republican Governor Gary
Herbert supported a more limited version of the expansion plan that would have
covered fewer residents that would require federal approval.
As we noted in our
item dated 5/4/18 below, Republican Governor Paul LePage continues to oppose
expanded Medicaid in Maine, prompting a lawsuit that is still pending
(5/4/18)- As we
noted in our item dated 11/9/17, Republican Governor Paul LePage continues to
resist attempts to make Maine the 32nd state to accept the terms of
the expanded Medicaid program under the Affordable Care Act. 59% of the state’s
residents voted in favor of accepting the program, and the governor has vetoed
legislation to join the program.
Mr. LePage is in the
final months of his 2nd term in office and Maine’s constitution
forbids him from running for a 3rd term. The governor missed an
April deadline to begin securing federal money for the planned Jul 2 Medicaid
expansion that he called a “boondoggle”.
Advocates who favor
the expanded program, which includes both Republicans and Democrats, have gone
to court to try and force the governor to act. The federal government presently
pays for 90% of the cost of the expanded program, although over the coming
years, the state will eventually pay for the full cost of it.
residents voted in favor of becoming the 32nd state to be covered
under the expanded Medicaid program enacted in the Affordable Care Act of 2010,
but limited by the decision of the U.S. Supreme Court. Maine’s Republican
governor Paul LePage has vetoed 5 attempts by the state’s legislature to expand
the program, and led the attempt to defeat the proposal.
government pays for about 90% of the expanded coverage, with the state paying
the other 10%. This ratio of spending by the federal government versus the
state’s expenditure will disappear over the coming years, so that eventually
the state will pick up the full cost of the program.
expanded Medicaid coverage filed a petition last week in Utah to place the
issue on the state’s 2018 ballot, and activists are looking to do the same in
(7/23/17)- The media
has focused much of its attention on various Republican legislators’ proposal
to cut-back on Medicaid spending under the Affordable Care Act. As a general
rule to be eligible for Medicaid, an individual can’t have a monthly income in
excess of $2,205, including Social Security. Each state has its own minimum
requirement, so this amount can vary slightly from state to state.
Again, as a general
rule, a spouse can have assets of up to $120,000, excluding home and car, for
an individual to qualify for Medicaid. If you are single, there is a cap of
$560,000 to $840,000 depending on individual state requirements in home equity
to qualify for Medicaid.
There is a 5 year
look-back period of time for gifts made by an individual seeking to qualify for
(7/6/170- There are
31 states and the District of Columbia that have expanded Medicaid programs
under the Affordable Care Act. Medicaid covers the expenses of more than 60% of
the 1.4 million nursing home residents, according to estimates from the Kaiser
About 21% of Medicaid
funding pays for nursing homes and other long-term care facilities The Kaiser
Foundation estimates that nursing home care typically costs $82,000 a year per
government pays 90% of the cost to the states that have joined the expanded
Medicaid program, with that percentage decreasing as the years go bye.
(5/2/17)- Florida is
one of the 19 states that did not opt for expanded Medicaid under the terms of
the Affordable Care Act, even though the federal government now contributes 90%
of the cost to the state.. Under the terms of regular
Medicaid the federal government, on average pays about 57% of the cost, with
the state paying 43% of that expense
The Urban Institute
estimated that between 730,000 to 900,000 Floridians would gain health
insurance if Florida joined the expanded Medicaid program
administration has worked out a deal with Florida wherein the federal
government would provide additional funding to the state’s “low income funding
pool”. The Obama administration was cutting back on this funding for state’s
that joined the expanded Medicaid program. In the case of Florida, that pool
funding from the federal government had dropped down to $608 million a year.
Under the Trump plan
that funding will now increase to $1.5 billion a year.
Andrew M. Slavitt,
the acting administrator of the Centers for Medicare and Medicaid Services
(CMS). From March 2015 to January 2017
called the low-income pool basically a slush fund and “is an inefficient
way to pay for medical care.”
Republican controlled Kansas House of Representatives narrowly upheld
Republican Governor Sam Brownback’s veto of the expanded Medicaid legislation
for the state. The vote was 81 to 44 leaving it short 3 votes to override the
legislators, who had previously voted against expanded Medicaid voted in favor
of the override, while 2 Republicans who had voted for the expansion, voted
against the override.
Governor Sam Brownback vetoed the bill that we discussed in our item dated
3/31/17 below that would have expanded Medicaid in Kansas. The bill had been
handily approved in both chambers of the Republican led legislative body, but
supporters will need to muster 3 additional votes in the House, and two in the
Senate to override the veto.
The state is running
a sharp deficit, but the Senate upheld Governor Brownback’s veto of a bill that
would have raised the state’s taxes
covers adults with incomes up to 138% of the poverty level- $16,400 for a
Republican led legislature in Kansas, over the objection of its Republican
Governor Sam Brownback, has voted to become the 32nd state, plus the
District of Columbia, to have an expanded Medicaid program under the terms of
the Affordable Care Act.
Virginia, Maine and
North Carolina have also initiated steps to join the program. Kansas Senate
Minority Leader, a Democrat said that up to 150,000 of the state’s resident,
who were uninsured could be covered by the program
Other states that
are expected to reconsider joining in expanded Medicaid coverage include Idaho,
Georgia, Florida, Missouri, Wyoming and Utah
(3/29/17)- With 31 states
and the District of Columbia now included in the Expanded Medicaid program,
nearly one in five Americans are included in this program. With 75 million
beneficiaries Medicaid now exceeds Medicare as far as total amount of people
Protection and Affordable Care Act of 2010 added 11 million people to the
Medicaid rolls. The independent agency projection of the Congressional Budget
Office (CBO) was that the Republican bill to replace Obama Care would cut 14
million beneficiaries off Medicaid, but would reduce spending by $839 billion
in the coming decade
The nation spent
more than $532 billion on Medicaid, of which about 63% was federal money.
Medicaid pays for the care for two-thirds of residents of nursing homes. That
comes to about 6 million Americans older than 64 in nursing homes.
government now pays 90% of the cost for the states in the Expanded Medicaid
program, with the next cut in that amount occurring in 2020.
Governor Rick Snyder of Michigan defended the state’s success with its expanded
Please keep in mind
that the Supreme Court in upholding the constitutionality of the Affordable
Care Act of 2010 ruled that the federal government could not force the states
into an expanded Medicaid program.. The states that
have joined the expanded Medicaid program have voluntarily done so.
government paid 100% of the cost to the states that did offer Medicaid coverage
in their first 2 years of participation in the program. That percentage will
decrease as the years pass.
are 31 states plus the District of Columbia that participate in the expanded
Medicaid program under the Affordable Care Act and the question now is what will President-elect Donald J. Trump stance is on it once he
Mike Pence, the
vice-president-elect, was instrumental as governor of Indiana in bringing that
program to that state. The Indiana expanded Medicaid program requires
beneficiaries to make monthly contributions to savings accounts used for
about 77 million people at a cost of over $500 billion between the federal and
state governments. Of the 20 million individuals who gained health insurance
coverage under the act, about 12 million are covered through Medicaid.
government paid the full cost of the expanded programs to those states
utilizing the program, but that will go down to 93% in 2019, as it gradually
(9/13/16)- We received the following e-mail from Max
Horowitz of Senior Planning, and we want to pass it on to our viewers who are
interested in finding out more about Medicaid. Thank you Mr. Horowitz
Date: 9 Sep 2016 16:08:13 +0300
Subject: Medicaid long term care guide
I have an easy to use, comprehensive Medicaid
long term care guide to add to your list of online resources: https://www.seniorplanning.org/long-term-care-medicaid-eligibility/.
There is no charge to use the resource and a guide like this does not exist anywhere else on the web. It's been listed by the NIH on their resources page so you can rest assured it's legitimate information (http://clinicalcenter.nih.gov/wecare/resources.html). If I've contacted the wrong department I'm sorry for the inconvenience; a redirection to the appropriate person would be very much appreciated.
I work with an organization called Senior Planning
and we provide free assistance to seniors and their families regarding elder
care and housing options.
If you have any concerns or would like to know
more about our organization, please email me and I would be happy to answer.
Feel free to peruse the guide to see if you think it is relevant for people who
might be visiting your site.
(4/23/16)- Republican Governor Asa
Hutchinson of Arkansas saved the state’s Expanded Medicaid program by vetoing
the budget presented to him. Arkansas’ Expanded Medicaid program was created in
response to the U.S. Supreme Court denial of the mandatory requirement that the
Affordable Care Act had set-up.
About 250,000 residents of Arkansas
are covered by the Expanded Medicaid program in that state. A provision in the budget
that was presented to Mr. Hutchinson that called for the ending on December 31
of the program.
Arkansas was the first state to win
approval for its hybrid Medicaid plan, under which the federal government would
pay 100% of the cost for the first 3 years, and 90% for the next 3 years. By
vetoing the provision in the budget bill to end the program, it would require
enough legislative votes to void his veto. Opponents of the expanded program
can’t achieve enough votes to override the veto.
(1/20/16)- Democratic Governor John
Bel Edwards signed an executive order making Louisiana the 31st
state plus the District of Columbia to have expanded Medicaid under the terms
of the Affordable Care Act (ACA). Mr. Edwards promised that he would expand the
state’s Medicaid program when he recently ran for the office.
Under the terms of the ACA, federal
funds will cover 100% of the cost, through 2016, for a state to include
everyone with incomes below 138% of the poverty level. That comes to $16,242
for a single person and $33,465 for a family of four. The federal government
will cover 90% of the cost to a state for expanded Medicaid for 3 more years
298,000 Louisans will be eligible
for Medicaid under the expansion, according to an analysis last year by the state’s
Legislative Fiscal Office. An additional 224,000 adults with private insurance
would also be eligible.
(10/21/15)- With 29 states accepting
the federal expanded Medicaid program, under the terms of the Affordable Care Act(ACA), spending on Medicaid rose nearly 14% on average in
the last fiscal year, according to a report issued by the Kaiser Family
Most of those 29 states showed that
the per-member, per-month of the new enrollees was, in fact lower than
expected, according to the report. Almost all of the additional spending was
covered by federal funds. Under the terms of the ACA the federal government
pays 100% of the additional cost to the state through 2016, and 90% of the
additional cost to the states through the fiscal year 2019
Republicans, who hold a majority in
the Utah House of Representatives, defeated a 2nd attempt Republican
Gov. Gary A. Herbert to have that state accept an expanded Medicaid program.. The governor’s plan would have added 95,000 adults
to the Medicaid program in that state.
Under the terms of the ACA, Medicaid
will accept nearly all adults with income up to 138% of the poverty level, or
$16,242 for an single person, starting January 2014
(8/26/15)- Updating our item dated
7/21/15 below, a committee of Alaska House and Senate lawmakers voted to sue
Independent Governor Bill Walker to try to prevent his effort to expand the
state’s Medicaid program.
The vote came after a closed-door
executive meeting of the legislature. Democratic Rep. Sam Kito was the lone
dissenter. Mr. Walker had moved to expand Medicaid coverage to people 19 to 64
who are not caring for dependent children, not disabled, not pregnant, and who
earn up to 138% of the federal poverty level.
Under the federal expanded Medicaid
program, the U.S. government would pay 100% of the additional cost through
2016, and 90% of that cost through 2019.
(7/21/15)- Independent Governor Bill
Walker of Alaska said that he planned unilaterally to accept the federal funds
available under the Affordable Care Act to cover about 42,000 more residents of
the state under the expanded Medicaid program.
Mr. Walker said he had sent a letter
to the state’s Legislative Budget and Audit Committee giving it a 45-day
required notice of his intentionto accept the federal
funds under the program. He said he was authorized to act under the state law, even if the
committee did not approve his action.
Under the expanded Medicaid program,
the federal government picks up 100% of the cost through 2016, and 90% of the
cost for the next 3 years. Mr. Waler, a former Republican had tried to get the
state’s legislative to approve the expanded program at its regular session, and
then again at a special session of that body, but to no avail.
There are presently 28 states and
the District of Columbia that have approved expanded Medicaid within their
(5/25/15)- In a letter to Florida’s
top health care official, the Obama administration said that it could authorize
$1 billion for the 2015 fiscal year and $600 million for the 2016 fiscal year to
reimburse hospitals in that state for treating patients who do not have
insurance. The cost would be shared by the state and federal governments. For
more info on this matter please see our item dated 5/3/15 below.
The $1 billion offer is less than
half of what the state requested for this fiscal year for the Low Income Pool
Program, which expires on June 30. State legislators will convene in a special
session on June 1 in order try try and pass a
balanced budget. Governor Rick Scott, the Republican governor of the state sued
the federal government claiming that the federal government was trying to force
the state to join the expanded Medicaid program.
The federal government has asserted
that if the state joined the expanded Medicaid program, it would funnel $2.1
billion into the state.
(5/3/15)- A wide split has developed
among the Republicans in Florida as to whether or not the state should expand its
Medicaid program under the terms of the Affordable Care Act. The Republicans
control both the House of Representatives and Senate in the state, and the
governor, Rick Scott is also a Republican.
Governor Scott and the House oppose
expanding the state’s Medicaid program, while the Senate is in favor of doing
The House adjourned three days
early, leaving in limbo Florida’s $77 billion budget deficit, and the expanded
Medicaid issue. The state must have a balanced budget in place by June 30, so a
special session will have to be convened to resolve the issues.
On the other hand, Obama
administration officials have made it clear that unless the Legislature adopts
some form of expanded Medicaid, it could lose more than $1 billion in federal
dollars, under the Low Income Pool program, to help hospitals care for
low-income patients who are uninsured. The federal aid is due to expire June
Governor Scott has filed a lawsuit
against the Obama administration to prevent it from making those payments to
the state. The difference over Medicaid expansion leaves a $4 billion gap
between the House and Senate budgets.
(4/17/15)- Under federal law, states
can recover almost all Medicaid costs if recipients are 55 or older when they
die. This same law applies to the estimated 11 million individuals who joined
expanded Medicaid programs in states that have such plans. Survivors can apply
for hardship exemptions, but will have to prove their cases to avoid having to
repay for the obligation incurred by a deceased member of the family.
Colorado, Connecticut, Oregon and
Washington have passed laws that scale back what costs can be recovered from
estates, and legislation is pending in California to do same. There are
presently 28 states that have expanded Medicaid programs, with several other
states looking to expand their Medicaid coverage.
Under the Affordable Care Act, the
federal government pays 100% of the costs for the expanded Medicaid program in
a state through 2016, and will pay 90% of the cost through 2019 for new enrollees
who are allowed to earn up to 138% of the poverty level..
As of November 2013, about 40 states had laws or policies to recover the costs
of all medical services received by Medicaid individuals over 55.
A report from the Inspector General
of the Health and Human Resources (HHS) last year estimated that states had
recovered almost $498 million from estates of Medicaid recipients.
(3/4/15)- Republican Governor Gary
Herbert of Utah criticized the state’s Republican controlled House for deciding
not to consider his plan for expanded Medicaid as called for under the
Affordable Care Act. Speaker Greg Hughes of the House said that it would not
consider the governor’s plan because it had no support.
The governor had negotiated his plan with federal officials, and it had been approved in the State Senate. Thus, there continues to be 28 states that have adopted some form of the expanded Medicaid program.
(2/12/15)- At last count there were 28 states that had joined, in some form or other, the expanded Medicaid program, under the Affordable care Act. Republican Governor Bill Haslam of Tennessee’s plan to join the program, that we wrote about in our item dated 12/18/14, was defeated by the Republican controlled legislature in that state. Wyoming’s plan to join the program was also defeated by the state’s legislative body.
Newly elected Democratic Governor Tom Wolf of Pennsylvania is scrapping his Republican predecessor’s plan for an expanded Medicaid program in favor of joining in with the “straight federal expanded Medicaid” program.
Republican Governor Gary R. Herbert has negotiated a tentative deal with Obama administration officials for an alternative expanded Medicaid program, but the Republican controlled legislature in that state will not go along with the deal. A vote is expected within the next few weeks on the deal.
(2/2/15)- Republican Governor Mike Pence of Indiana announced that the state would join the expanded Medicaid program, after the state had obtained certain concessions from Obama officials. Under Indiana’s agreement, the state can require some Medicaid enrollees to contribute toward their medical care.
It is estimated that about 350,000 residents of the state would qualify for the coverage beginning February 1. The Medicaid program covers about 50 million people in this country. The expanded Medicaid program is aimed at covering residents of a state who earn up to a third more than the federal poverty level, or around $15,500 for a single adult.
Indiana’s agreement is the first time a state has been allowed to impose strict requirements on some Medicaid enrollees to pay a portion of their premiums, up to $26 a month for a single adult, or get locked out of the program.
Under the Indiana waiver, new beneficiaries in the program with incomes under the poverty level of around $11,700, for a single adult, would be required to pay 2% of their month’s income, or lose benefits. All enrollees would be required to pay at least $1, and the fees could go up to $20, for a single adult, or more for a family.
Individuals making a little above the federal poverty level would also be required to make a 2% contribution which could range from about $20 to $26 a month for a single adult, and they could be locked out of coverage for 6 months if they fall behind in their payments. Many of the enrollees would have copays of up to $25 for repeat inappropriate visits to emergency rooms.
(12/18/14)- Republican Governor Bill Haslam of Tennessee announced his plan to make that state the 28th state to have an expanded Medicaid program under Affordable Care Act. The federal government pays 100% of the cost for the increased number of residents of the state that become covered, and 90% of the cost for the next 3 years thereafter under the terms of its expanded Medicaid program.
His expanded Medicaid coverage still has to be approved by the state’s Republican controlled legislature, and requires a final approval by Obama officials. Under Mr. Haslam’s plan, residents of Tennessee who meet the income criteria would become eligible for fixed-cost vouchers that they could use to enroll in their employer’s plan.
Others would be enrolled in a special category in the state’s Medicaid program, called Tennessee Care, in which they likely would be required to pay a part of their costs, but could also receive health savings accounts with government contributions based on their participation in disease-prevention activities.
Mr. Haslam’s plan would cover individuals who earn up to $16,100 for individuals. His plan called for a 2 year trial period, and the state would not incur any additional costs during that period of time. He will convene a special session of the legislature in January to approve his plan.
(12/10/14)- A report issued by the inspector general of the Department of Health and Human Services concluded that half of the doctors listed as serving Medicaid patients are not available to treat them, either because they were not accepting new Medicaid patients, or could not be found at their last known addresses.
With expanded Medicaid coverage being offered in 27 states, enrollment is up by nine million people, or 16% in the last year, according to the study. Many of the new enrollees are in private health plans, but the inspectors found that many of the doctors were unavailable to take on new patients.
More than one-third of the providers could not be found at the locations listed by the Medicaid managed-care plan. Investigators called 1,800 providers listed by more than 200 health plans under contract with Medicaid in 32 states. In all cases, the insurers confirmed that the doctors were supposed to be taking Medicaid patients.
The median wait time for an appointment was 2 weeks, with primary care physicians less likely to provide appointments than were specialists.
(10/28/14)- Federal officials now estimate that in the last year, 8.7 million people have been added to the Medicaid rolls. Of the 8.7 million, 7.5 million have come from the 27 states that have taken advantage of the expanded Medicaid program under the Affordable Care Act.
Under that program, the federal government pays 100% of the cost incurred by the state for those who joined under the increased parameters for eligibility through 2016, and then will pay 90% of that cost for 3 years thereafter.
The state normally pays about one-half of the cost for Medicaid expenses incurred by its residents and the federal government pays the other half. Expanded eligibility includes people with incomes up to 138% of the poverty level, which is $16,105 for a single person.
In addition to the 27 states in the expanded Medicaid program, 9 states with Republican governors are expected to join the program shortly. Republican governors in Indiana and Utah are negotiating with administration officials on possible expansion.
The Republican governor of Tennessee hopes to be able to join the expanded program in spite of opposition from members of his own party.
(4/18/14)- In states that have accepted expanded Medicaid in February, enrollment increased by 8.3% to a total of 35 million people by the end of that month. In states that have not accepted expanded Medicaid, enrollment was up by only 1.6 per cent.
For a nation as a whole, about 3 million more people have been enrolled in Medicaid by the end of February, bringing that total to 62 million. States with the largest percentage increases included, Oregon, West Virginia, Vermont and Colorado, all of which had expanded coverage.
Individuals can sign up for Medicaid at any time. The Affordable Care Act simplifies the application procedures and required the states to upgrade Medicaid information systems so that the federal government can gather and divulge that information in a much timelier manner.
As a general rule, Medicaid eligibility is for anyone under 65 whose income is up to 138% of the federal poverty level (up to $16,100 for an individual and $32,900 for a family of four).
(4/7/14)- 24 states and the District of Columbia have accepted the federal government’s offer to pay 100% of the cost for the next three year to expand their Medicaid rolls, and 90% of the cost for the three years thereafter. As we noted in our items dated 3/28/14, the federal government is also helping to pay the cost of “private expanded Medicaid” in several states.
The states that are most likely to follow the path taken by Arkansas and New Hampshire are Indiana, Tennessee, Utah and Virginia.
With the number of people now having health-care coverage, the nation is faced with the fact that there are not enough medical professionals around in many areas of the country to serve this expanded market of individuals seeking medical treatment. Community health centers hopefully will help alleviate this situation.
The Affordable Care Act provides $11 billion over 5 years to expand these clinics. Most states have contracts with insurance companies or other entities that are supposed to manage care for Medicaid beneficiaries and connect them to doctors.
(3/28/14)- New Hampshire’s Democratic Governor Maggie Hassan has signed the legislation that extends the private expanded Medicaid option that we discussed in our item date 3/9/14 below. The first phase of their plan would help subsidize employer-based coverage for about 12,000 individuals. The second phase will go into effect in July and would consist of about 38,000 individuals who would be covered by the state’s Medicaid-managed program in July.
(3/9/14)- According to the latest data from the Centers for Medicare and Medicaid Services (CMS), 8.9 million individuals were determined to be eligible through state agencies from October to January for Medicaid. Most of these individuals enrolled in the state exchanges are in addition to the 1.17 million determined eligible through the federal exchange.
1.5 million Individuals were deemed eligible for expanded Medicaid in states that had accepted the program and 900,000 were eligible in states that had not accepted it.
After 4 previous failures to garner enough votes in the Arkansas Republican controlled House of Representative, that legislative body recently voted to extend coverage for another year under the so-called private option. Nearly 100,000 residents of the state have enrolled in the coverage so far, and this number will grow even larger after Governor Mike Beebe, a Democrat signs the measure, which he is expected to do.
Arkansas’s private option allows the state’s residents to choose among plans offered by four companies on the state’s new health insurance exchange. Iowa and New Hampshire have adopted versions of the Arkansas private plan and Pennsylvania and Utah have private health insurance plans under consideration.
The Arkansas state Constitution required a three-fourths vote to reauthorize financing for the program in the House, which has 100 members, and in the Senate which has 35 members. The House, on its fifth try, voted in favor by a vote of 76 to 24. The Senate had previously voted to reauthorize the financing..
The state will not be allowed to finance advertising of the program. People earning up to 138 percent of the feder4al poverty level, or $15,900 for a single individual. are eligible for Medicaid, or in Arkansas, for private coverage, paid for with Medicaid funds, under the terms of the expansion.
Obama administration officials agreed to waive certain provisions of Medicaid law for three years to allow Arkansas to prove the effectiveness of its program. It is estimated that the program costs about $476 per person, per month.
The Republican dominated Senate in New Hampshire voted to expand health care coverage to an estimated 50,000 adult resident using funding made available through the Affordable Care Act. The House had already passed the measure and Democratic Governor Maggie Hassan is expected to sign it.
This private option differs from the regular expanded Medicaid option that has been accepted in 26 states and the District of Columbia. The first phase of the New Hampshire plan would subsidize employer-based coverage for about 12,000 individuals. A second group of about 38,000 would be covered by the state’s existing Medicaid managed-care program in July. Those adults would transition to private health care plans at the beginning of 2016. Federal waivers must be approved for each step to take place.
The program would end in 2016, when the federal government’s contribution would drop from 100 percent to 90 percent for the next three years, unless it was reauthorized.
(3/13/13)- Under the terms of the Patient Protect and Affordable Care Act of 2010 (PPACA) states have the option of expanding Medicaid coverage to low income adults, ages 19-64, with incomes below 133% of the federal poverty level (FPL). New federal match rates will provide 100% federal funding for the care of the newly eligible population for the first three years starting in 2014. Funding will be gradually reduced to 90% of the total spending by 2020.
To date, 24 states and D.C. have decided to expand coverage, while 14 have opted not to expand it. Of the remaining states, 4 are leaning towards expansion, 3 are leaning against it, and 5 are undecided.
For more info on the Patient Protect and Affordable Care Act of 2010, please see our article on this topic.
(11/12/12)- The Supreme Court ruling that upheld the constitutionality of the Patient Protect and Affordable Care Act of 2010 held that the states do not have to participate in the expansion of Medicaid coverage if they chose not to do so. For those who do, the federal government would pay the full cost of the expansion for the first 3 years starting in 2014.
The federal government would reduce that percentage of full payment to 90% in 2020 and beyond.
Medicaid now pays for people with incomes up to 133% of the poverty level. The federal government pays for about half the cost of Medicaid and the states pick up the other half of the cost.
(11/1/12)- Spending on Medicaid decreased sharply last year, according to a survey from the Kaiser Family Foundation. For the fiscal year that ended this past June, total spending on Medicaid grew by only 2%, which was sharply lower than the10% increase in 2011, and one of the lowest rates on record.
Enrollment growth slowed to 3.2% for the year ended June, as opposed to the 4.4% growth rate in 2011, and 7.2% in 2i010.
Spending cuts accounted for a large part of this decrease, with reimbursement rates being cut for hospitals, doctors' visits, and for optional benefits like dental, vision and drug coverage. Forty-five states cut or froze reimbursement rates last year, according to the report. Many of the states switched to managed care plans for Medicaid beneficiaries.
Ex-governor Mitt Romney is proposing to replace the current Medicaid program with one of block grants to the states, giving each state a fixed amount of federal funds, and letting them determine eligibility and benefit levels. The federal government currently sets minimum requirement, like covering all children under poverty levels, and providing unlimited matching funds.
(10/5/12)- Obama officials released their first definitive guidelines since the Supreme Court ruling in June respecting the expansion of Medicaid as an option that will be available to the 50 states.
Under the Supreme Court ruling the expansion is an option, not a requirement for the states to follow. Under the terms of the Affordable Care Act, Congress required states to expand Medicaid coverage for people under the age of 65 with income less than or equal to 133% of the federal poverty level (up to $25,900 for a family of three).
Under the guidelines, the federal government will pay the entire cost of Medicaid coverage for newly eligible beneficiaries for three years, from 2014 to 2016. That share will decline to 95% in 2017, 94% in 2018, 93% in 2019 and 90% in 2020 and later years.
Cindy Mann, the federal official in charge of Medicaid, said, "A state may choose whether and when to expand, and if a state covers the expansion group, it may decide later to drop the coverage."
(9/10/12)-There are 1.8 million nursing homes in this country. 31.5% of Medicaid's $400 billion in shared federal and state spending goes to long-term care for the elderly and the disabled.
To be eligible for Medicaid, a person typically can have no more than $14,800 in assets. New York has the biggest Medicaid budget of any state at $54 billion, and spends about 41% of it for long term care, almost half on nursing homes.
By 2015, New York will start requiring some 78,000 nursing home residents to choose one of several managed care plans or be enrolled randomly in one of them.
Children could be liable for Medicaid expenditures for their parents under pending new laws. A 2009 analysis by the Kaiser Foundation found that direct out-of-pocket sending by individuals and families accounts for 22% of the $178 billion spent on nursing homes.
(2/22/12)- Starting in 2014, people with family incomes up to 138% of the poverty level ($31,809 for a family of four and $15,415 for a single person in 2012) will be generally eligible for the Medicaid program. People buying coverage in the new state-based health insurance exchanges will be eligible for federal subsidies to subsidize the cost of insurance if their income is below four times the poverty level ($92,200 for a family of four and $44,680 for a single person in 2012).
(7/27/11)- As the states search for ways to reduce their budget deficits it is becoming quite clear that Medicaid is one of the prime areas that they are looking at as they seek to reduce their expenditures. Medicaid is paid for through federal and state contributions so it is a prime target to be cut on both the federal and state level.
Ten hospitals sued the state of New Hampshire in federal court over the state's payments to them for caring for Medicaid patients, claiming them to be inadequate. The lawsuit claims that the state is jeopardizing the poors access to health care under the federal Medicaid Act by providing insufficient payment to them and doctors to treat Medicaid patients.
(10/3/10)- An additional 3.7 million people joined the Medicaid program last year, the largest single-year increase since the early days of the government program, according to data from the annual survey of the Kaiser Family Foundation, an independent nonprofit group that conducts research on health policy matters.
Enrollment in the program grew by 8.2 percent from December 2008 to December 2009, the second largest rate of increase in the 10 years that Kaiser has conducted the survey.
There were 48.5 million people on Medicaid at the end of 2009, or about one in six Americans. Every state showed enrollment growth, with nine states above 15% and Nevada and Wisconsin above 20%.
Spending on Medicaid grew 8.8% in 2009, the largest percentage increase since 2002. The stimulus package of $781 billion included $87 billion in Medicaid relief for the states, and Congress extended the assistance, at a reduced level, through June 2011.
Under the new health-care law passed this year, starting in 2014, the program will become available to able-bodied adults with income up to 133% of the federal poverty level (currently 414, 404 for a single adult and $29,326 for a family of four.).
The government expects the Medicaid expansion to account for about half of the 32 million uninsured people who are projected to gain health-care coverage because of the new law.
Virtually every state made cuts to benefit levels or provider payments in order to help balance their budgets. 39 states cut or froze payment to providers, including 20 states that reduced rates for doctors.
As a condition or receiving stimulus money, states were prohibited from lowering eligibility thresholds, which they are allowed to set within federal parameters.
(2/8/09)- For 2009, federal guidelines allow couples to keep up to $2,739 a month in combined income and $109,560 in assets, not including a home or car and still have Medicaid cover nursing home costs. There is a five year look-back on assets that are gifted by a Medicaid or Medicare beneficiary.
(12/16/08)- Your state may help pay for Medicare expenses through the Medicare Savings Program if:
(10/24/06)- If you are a New York City resident there is now an online tool that allows residents to see if they are eligible for up to 21 government programs, including Medicaid, food stamps, child care, Head Start, and tax and rent exemptions.
In addition to English the tool is available in Spanish, Chinese, Korean, Russian, Arabic and Haitian Creole. The tool is available at nyc.gov and is intended to ease the application process and cut down on office visits and paperwork. Eventually, users will be able to submit their information to city caseworkers electronically.
The first phase of the project cost $8.5 million; the second phase, costing $14 million and incorporating more programs, is to be completed next year.
(9/29/06)- Kelly Greene in her September 26, 2006 column in the Wall St. Journal entitled "Ask Encore" points out that the federal law requires the state's Medicaid program that paid for the care of a Medicaid patient may be entitled to reimbursement for the expenditures. Medicaid is a program that is run jointly by the federal government and the state's Medicaid department.
The recovery rule varies from state to state, so you have to check with the state Medicaid department that covered the costs of the Medicaid beneficiary to see what the rules are pertaining to recoveries from any of the estate assets. Thus if a beneficiary had a home, the state and the federal government may be able to recover some of their expenditures by selling the home after the death of the Medicaid patient.
(1/8/06)- Congress recently enacted changes in Medicaid coverage for nursing home care so that a nursing home resident whose home equity exceeds $500,000 would not be eligible for Medicaid coverage. A provision in the rules would allow individual states to increase this limit to $750,000
The changes enacted allow states to charge higher premiums and higher co-payments for a wide range of Medicaid benefits, including prescription drugs, doctors' services and hospital care. Medicaid recipients can be charged 10% of the cost of any item or service if their family incomes were 100% to 150% of the federal poverty level, $12,830 to $19,245 for a family of two. Recipients above that can be required to pay 20% of the cost of any item or service.
Total co-payments for all people in a family cannot exceed 5% of family income. States would not have to provide a Medicaid recipient with all the services now required by federal low, but can off a more modest package of benefits resembling commercial insurance. States will be allowed to end Medicaid coverage for people who fail to pay premiums for 60 days or more. Pharmacists can refuse to fill prescriptions and doctors and hospitals can deny services for recipients who do not make required co-payments.
(9/18/05)- A new homestead exemption law went into effect in New York State on August 31 that allows a person to protect $50,000 of equity in an individuals home from creditors. Thus a husband and wife can protect up to $100,000 in equity in their home from their creditors. The previous level had been $20,000.
The homestead provision had been introduced in every legislative session since 1992, but had never been able to get past the Republican Senate. This year, Senator Vincent L. Leibell, a Putnam county Republican backed the measure and was instrumental in getting it passed.
The new federal bankruptcy law, which tightens up the law considerably, goes into effect on October 17th. That law will make it more difficult for people to claim bankruptcy and discharge their debts. Elizabeth Warren, a Harvard bankruptcy researcher, said the change in homestead protection would ultimately have greater impact in New York than the federal bankruptcy overhaul.
Some states like Texas allow homes to be withheld from creditors no matter what their value may be.
(4/19/05)-Medicaid is a program that pays for medical assistance for certain individuals and families with low incomes and resources. This program became law in 1965 and is jointly funded by the Federal and State governments (including the District of Columbia and the Territories) to assist States in providing medical long-term care assistance to people who meet certain eligibility. Medicaid is the largest source of funding for medical and health-related services for people with limited income.
For more information on Medicaid: www.cms.hhs.gov/medicaid
Medicaid Information for States and Territories- www.cms.hhs.gov/default.asp
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
Allan Rubin and Harold Rubin
updated March 23, 2021