A cornerstone of the Affordable Care Act of 2010 (ACA) is making healthcare coverage available to the millions of people who currently cannot afford it. As part of this, the law calls for expanding Medicaid to cover people under age 65 with income of 133 percent of the federal poverty line (FPL) starting in 2014. This is estimated to increase the number of people currently in Medicaid by at least 15 million. (The federal poverty line is $23,050 for a family of four in 2012.) However, the U.S. Supreme Court ruling on Medicaid expansion under ACA essentially makes complying with this provision optional for states.
As a result, each state is able to determine whether or not to participate in the expansion. This uncertainty is important because ACA also has an individual mandate: all U.S. citizens and legal residents will be required to have qualifying health coverage starting in 2014.
This means millions of people will be worried about how they are going to pay for healthcare coverage—and wondering, will they or won’t they be able to receive benefits under Medicaid in the state where they live. This is particularly true for people with disabilities who often have dwindling income and resources, significant medical needs and limited access to healthcare coverage.
Medicaid and Disability Today
Before looking at possible Medicaid coverage scenarios under ACA, it’s useful to look at the current situation. Today, more than one-third of individuals with serious disabilities will lose their health insurance while awaiting SSDI benefits, based on research by Allsup, a company that provides Social Security Disability Insurance (SSDI) representation. These people may lose their healthcare coverage for a variety of reasons, but often it’s because they can no longer afford the premiums.
Currently, Medicaid provides health benefits for some people with low incomes, including children, parents with dependent children, seniors and people with disabilities. As a result, if you have a disability, you may qualify for Medicaid if your income and assets meet your state’s requirements.
People with Disabilities and Medicaid Expansion Opt-In States
States opting into Medicaid expansion appear to be in the minority. For example, a July MSNBC analysis finds leaders in more than half the states have indicated they are against or appear to be leaning against expansion. States planning or leaning toward participating include Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Minnesota, Oregon, Rhode Island, Vermont and Washington, and the District of Columbia.
Starting in 2014, people with disabilities living in participating states will find it easier to get Medicaid. The expansion means that any adult who earns less than 133 percent of the federal poverty level in these states can sign up for Medicaid – regardless of whether they are disabled and their assets generally are not considered when determining eligibility.
People with Disabilities and States Opting Out of Medicaid Expansion
States indicating they will not or likely will not expand Medicaid (based on the same MSNBC analysis) include Alabama, Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Louisiana, Maine, Michigan, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin and Wyoming.
While many states have not fully committed one way or another, states that choose to opt out of the Medicaid expansion may find they are creating a new “at risk” population: individuals and their families who are required to have healthcare coverage, but are unable to qualify for Medicaid and unable to afford private coverage.
Some people may benefit from state exchanges, which will come online in 2014 and are designed to help people and small businesses find affordable healthcare coverage.
ACA also provides tax credits for premiums to people with income between 100 percent and 400 percent of the federal poverty level ($23,050 to $92,000 annually in 2012 for a family of four). The premium credit varies based on income. The person pays a portion of the premium, and a tax credit may cover the rest or a significant portion of the remaining premium, depending on the type of plan selected. However, even that may be more than some individuals with limited means can afford.