How will the Affordable Care Act affect Medicaid in Pa., N.J. and Del.?

Got questions about the Affordable Care Act? WHYY/NewsWorks Health and Science Desk provides “The Short Answer.”

Question: How will Medicaid change under the Affordable Care Act?

Got questions about the Affordable Care Act? In a regular feature, the WHYY/NewsWorks Health and Science Desk is providing “The Short Answer.”

Today’s question

How will Medicaid change under the Affordable Care Act?

The short answer

The short answer is more people will qualify for Medicaid under the Affordable Care Act, but it all depends on where people live, their health status, age and income.

The expansion, for the most part, applies to low-income adults who don’t have kids and aren’t already eligible for Medicaid because of certain health needs or disabilities. It may also affect some low-income parents.

More details

Under an expansion, any adult earning up to $15,000 a year would be eligible for Medicaid. That translates to an income of about $1,300 a month or about 138 percent of the federal poverty level. (Currently in most states, no matter one’s income, an adult without children is not eligible for Medicaid. For the most part, this is not the case in New Jersey and Delaware and for some working adults in Pennsylvania.)

In June 2012, the U.S. Supreme Court ruled that the Medicaid expansion under the Affordable Care Act is optional for states. It has become one of the most contentious parts of the law. For states that have decided to sign on, an expansion takes effect as early as January 2014. Here’s what’s happening in the Philadelphia region:

• New Jersey is expanding Medicaid. Generally speaking, a childless adult in New Jersey who makes up to about $3,000 a year and qualifies for General Assistance is currently eligible for Medicaid. Some people who earn more than that but have very specific health situations also qualify.  The expansion will raise that income eligibility to $15,000 a year. New Jersey officials expect about 100,000 people will become eligible for Medicaid as a result of the change.  

• Pennsylvania has not signed on for an expansion. Generally speaking and setting aside special situations such as domestic violence that could make a person eligible for the program, the current income eligibility for a childless adult or a parent is about $5,500 a year (or 47 percent of the federal poverty level). Consumer advocates and state officials are concerned that most of those individuals who would be eligible for Medicaid under an expansion (an estimated 600,000 by their count) will be left to buy insurance on the private market without any sort of financial assistance.

• Delaware is moving forward with a Medicaid expansion. Currently an individual in that state making up to about $1,000 a month is eligible. Again, under an expansion, income eligibility would go up to about $1,300 a month. State officials are expecting anywhere from 25,000 to 35,000 people to gain coverage as a result of the change.

Expansion aside, the Affordable Care Act also makes other across-the-board changes to Medicaid. That includes raising how much money primary care doctors receive for caring for Medicaid patients and allowing people in the foster system to stay enrolled in Medicaid longer.

Medicaid 101

Medicaid is the largest health insurance program in the United States, covering more than 60 million people, according to the Kaiser Family Foundation. It covers nearly one in five residents, for example, in Pennsylvania. It’s state run, but there are certain federal coverage requirements that must be met in order to receive federal funding. Generally speaking, it’s aimed at low-income families, kids, seniors and people with special health needs.

Not Medicare

Medicaid is also not to be confused with Medicare, though the mix-up happens all the time, according to Donna Morgan, a spokeswoman with the Pennsylvania Department of Welfare. Medicare is the health program for seniors, aged 65 and older, regardless of income. With Medicaid, “think about that aid,” Morgan advised, as it’s the public health plan “for people out there who need medical coverage but have less income.” Some people, however, are eligible for both programs.

A big aspect of Medicaid that often gets overlooked is that it’s the main financer of long-term care in the U.S. Medicare does not cover such continued services for seniors. According to the Kaiser Family Foundation, more than 60 percent of people living in nursing homes have Medicaid. In Pennsylvania, for example, seniors and those with disabilities make up less than half of the number of people in Medicaid, but they account for two-thirds of the cost.

In other words, Medicaid costs a lot, but it also covers a lot.

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The 2010 health law goes into full effect Jan. 1, 2014. How will it affect you, your wallet and your health? Email your questions to healthandscience@whyy.org or tweet us @newsworksWHYY.