Constant changes to Medicaid can become overwhelming for Medicaid recipients and their caregivers. Family caregivers need to understand how Medicaid expansion impacts coverage. Not every state selected Medicaid expansion, and the difference in coverage can vary significantly between states. How does Medicaid expansion affect family caregivers?
Medicaid expansion refers to a provision of the Affordable Care Act (ACA), also known as Obamacare, that allows states to extend Medicaid eligibility to a larger number of low-income individuals and families. Medicaid is a joint federal and state program that provides health coverage for people with low income, including some low-income adults, children, pregnant women, elderly adults, and people with disabilities.
Before the ACA, Medicaid eligibility was more restricted, and many low-income adults without dependent children were often excluded from coverage. As outlined in the ACA, Medicaid expansion allows states to broaden eligibility criteria to include more low-income individuals, particularly those with incomes up to 138% of the federal poverty level.
Under Medicaid expansion, the federal government provides increased funding to states to cover the costs of expanding Medicaid, with the federal government covering a significant percentage of the costs. The goal is to reduce the number of uninsured individuals and improve access to healthcare services for low-income populations.
Not all U.S. states have chosen to expand Medicaid. The decision to expand Medicaid is at the discretion of individual states, and some have opted to do so, while others have not.
To determine if you or your care recipient may qualify for Medicaid based on the rules in your state, you can use an online eligibility tool. Input details like:
Even in states that haven't expanded Medicaid, you should still apply since you or your loved one may qualify under different eligibility pathways, like having a disability, being pregnant, or meeting income limits for parents/caretakers.
To apply for Medicaid, submit an application to your state Medicaid agency directly or through the health insurance marketplace. Be prepared to provide extensive documentation, including proof of identity, state residency, household income and assets, information on all household members, and anything else required to determine eligibility. You may also have to complete an interview by phone or in-person to clarify application details.
After submitting the Medicaid application, wait for an official determination of eligibility and enrollment in a Medicaid-managed care plan if your state requires plan selection. This waiting period can take over 45 days.
You or your loved one may not qualify for Medicaid for various reasons. If your income is too high for Medicaid and too low for marketplace subsidies, options like community health centers for low-cost care or catastrophic health plans may be available. It's also important to check eligibility whenever your income changes significantly.
Get care at a nearby community health center. The healthcare law expanded funding to these centers, providing millions for primary care. They offer services based on your income. Check how to get affordable care in your area.
Catastrophic health insurance is a type of bare-bones health plan that provides limited coverage in the event of a major medical emergency or illness. Here are some key things to know about catastrophic insurance plans:
Catastrophic health plans provide a low-cost way to protect against worst-case medical scenarios but have minimal benefits beyond that.
If income rises above 400%, you may still get savings. You'll find out when you apply. In these cases, and if income is at or below 150% of the federal poverty level, you may qualify to enroll in a Marketplace plan anytime if you contact them within 60 days of the income change. You'll need to attest that:
Monitoring income changes lets caregivers access coverage.
If your state has expanded Medicaid, you may be able to get coverage for an adult family member with income up to about $18,000 per year. Check your state's Medicaid website to confirm it has expanded and see eligibility rules. Then, you can apply online, by paper application, or in person.
Have income verification and other required documents ready. List your family member as the applicant and provide their demographic and financial information. Medicaid will determine if they qualify based on expanded income limits in your state. With approval, they can use Medicaid for doctor visits, prescriptions, and other health services.
There is no definitive end date for Medicaid expansion. The Affordable Care Act (ACA) authorized Medicaid expansion as a permanent option for states and provided an enhanced federal matching rate (FMAP) for their expansion populations. The FMAP for expansion states is currently 90% and will remain at that level indefinitely unless Congress changes the law.
Medicaid continuous enrollment and Medicaid expansion are not the same things. They are both related to the eligibility and coverage of Medicaid but have different meanings and implications.
Medicaid continuous enrollment is a provision that was enacted by the Families First Coronavirus Response Act (FFCRA) in 2020, which required states to maintain continuous coverage for most Medicaid enrollees during the COVID-19 public health emergency (PHE) by prohibiting termination of ineligible individuals as a condition for receiving a temporary increase in the federal Medicaid match rate1. This provision was critical in ensuring that Medicaid enrollees maintained access to essential healthcare services during the PHE and economic instability. However, this provision ended on March 31, 2023, as part of the Consolidated Appropriations Act, 2023, which also phased down the enhanced federal Medicaid matching funds through December 2023.
Medicaid expansion is a provision of the Affordable Care Act (ACA) that was designed to increase coverage for non-disabled adults under 65 who have low incomes with a primary goal of reducing the coverage gap between those who need health insurance but cannot afford it and those who qualify for financial assistance but do not enroll in private plans through the health insurance marketplaces.
As a family caregiver, research the benefits available in your state, including covered services, prescription drug formularies, and provider network limitations. Verify the program adequately covers the needs of your family member.
If transitioning between Medicaid programs when moving states, coordinate closely with your care team to transfer care plans, medical records, and prior authorizations to new providers while avoiding gaps in coverage. Choosing the right Medicaid health plan and updating your contact details with the Medicaid agency are vital steps.
