Medicaid Expansion-Health Insurance Exchange Subsidies – Post Supreme Court

The Affordable Care Act (ACA), as enacted, envisioned Medicaid eligibility expansion to persons under 133% of poverty and possible subsidies and/or income tax credits for persons to purchase private health insurance through health insurance exchanges when their income is between 133% and 400% of poverty. Now, consistent with the Supreme Court’s ACA decision, the Medicaid expansion is a state option while the exchange subsidies continue. Thus, if a state chooses not to expand Medicaid eligibility, persons between the current state Medicaid eligibility level and 100% of poverty might continue to be uninsured.

Health insurance coverage, beginning January 1, 2014, will expand by:

1. All individuals under the age of 65 with incomes at or below 133% of the federal poverty level (FPL), regardless of disability or health condition, may qualify for Medicaid and CHIP (Children’s Health Insurance Program), at state option. The Supreme Court modified the ACA requirement as a state option. The law allows the first 5% of income to be dis-regarded, thus, one may see 138% of the federal poverty level as the cited eligibility baseline.

2. Individuals without an offer of affordable employment based coverage, regardless of disability or health condition, can obtain private health insurance through health insurance exchanges, by:

a.      Adults over the age of 18 with incomes 133-400% of FPL will be eligible for cost-sharing and premium subsidies.

b.      Children under the age of 18 with family incomes 133-400% of FPL will be eligible for either CHIP or premium subsidies.

c.      Individuals not otherwise eligible for other coverage who earn up to 400% of FPL may receive premium tax credits, provided in advance, in order to purchase health insurance through the exchanges.

d.      Individuals without an offer of affordable employment-based coverage and incomes above 400% of FPL may obtain health insurance through the exchange.

e.      Consumers have the option of enrolling in COBRA or the exchanges at the time of the loss of employer coverage.

 3. Income tax subsidies might be available for persons under 100% of povery. This remains unclear.

 [HHS Poverty Guidelines: in 2011: one person under the age of 65, $11,702; four person household, $23,201]

Excellent and detailed analyses include: