The Fiscal Facts about Medicaid Expansion - Doctors for America

The Fiscal Facts about Medicaid Expansion - Doctors for America

Currently, the federal government requires that Medicaid be available to adults who 1) fall under the federal poverty line and 2) who have children, are pregnant, or are disabled. Although Medicaid is almost entirely administered by the states, including actual enrollment of beneficiaries and reimbursement to health care providers, the cost is split between the federal and state governments, with the federal government shouldering, on average, about 57% of cost.

There are two ways that the ACA will expand enrollment in Medicaid. First, the ACA makes more Americans eligible for the program by 1) increasing the income standard to 133% of the federal poverty level (in 2011 this was $10,890 for individuals and $22,320 for a family of four), and 2) doing away with the requirement that you must have children, be pregnant, or be disabled. The ACA ensures that the Federal government would pay for 100% of this the first 3 years, then phase down to 90% after 2020 and beyond. According to the Congressional Budget Office and the Center for Budget and Policy Priorities, this averages to the Federal government paying for 93-94% of the expansion over the rest of the decade.

The second way is that the ACA simply makes it easier for eligible Americans to enroll in the program. The little known truth is that there are millions of Americans who are already eligible for Medicaid but are not enrolled because of complicated paperwork for potential beneficiaries and for state agencies and providers. In fact, a New England Journal of Medicine paper reports that only 62% of all eligible individuals are enrolled in Medicaid, with some states like Oklahoma, Texas, and Florida enrolling under 48%. The issue is even more is true for children; 60-70% of uninsured children are eligible for Medicaid or State Children’s Health Insurance Programs (CHIP) eligible but are not enrolled.

Sphere: Related Content