#1 - Medicaid Expansion is the only way for people below 100% of poverty to gain coverage
The affordability in the Affordable Care Act Act (ACA) comes from two places. For persons with incomes between 100% and 400% of the Federal Poverty Level (FPL), refundable tax credits were offered through the health benefit exchanges. For persons whose income was less than 138% of poverty and who did not qualify for Medicare or Medicaid, expanded eligibility for Medicaid would be the means for gaining affordable coverage.1 As enacted, the ACA required states to participate in Medicaid expansion.
The Supreme Court ruling on the constitutionality of the Affordable Care Act included the finding that states could not be compelled to participate in expanded eligibility.2 As a result, states have the option to participate in Medicaid expansion. Nebraska has a decision to make.
The groups most likely to qualify for expanded Medicaid are: 1) single adults between the ages of 18 and 64 without children in the household with incomes below 138% of FPL; and 2) parents in households with incomes between 50% and 138% of FPL. The Nebraska Department of Health and Services has developed an overview of Medicaid eligibility that is linked in the footnotes below.3
The following table shows the poverty levels for households of different sizes. 4
100% 138% 400%
1-person household $11,170 $15,415 $44,680
2-person household $15,130 $20,879 $60,520
3-person household $19,090 $26,344 $76,360
4-person household $23,050 $31,809 $92,200
If Nebraska decides to participate in Medicaid expansion, persons with incomes below 138% of FPL would be eligible to receive coverage through Medicaid. Those with incomes between 138% and 400% of FPL would be eligible for refundable tax credits that would be used to offset premium costs for policies purchased through the Health Benefit Exchange.
If Nebraska opts out of participation, persons with incomes between 100% and 400% of FPL will be eligible for tax credits through the exchange. There will be no option for coverage for persons with incomes below 100% of the FPL.
AARP believes that Nebraska should participate in Medicaid expansion so that persons with incomes below the poverty level who are not eligible for Medicaid can get affordable coverage.
This fact sheet is brought to you by AARP Nebraska. For more information, contact Mark Intermill at 402-323-5424 or mintermill@aarp.org.
Footnotes
1 A description of the coverage options can be found at the website developed by the U.S. Department of Health and Human Services to provide information about the Affordable Care Act. The link is to an implementation timeline which is linked to a description of both Medicaid and Tax Credits. http://www.healthcare.gov/law/timeline/full.html
2 The Supreme Court opinion on NFIB v. Sebelius may be accessed through this link. The decision pertaining to the Medicaid expansion begins at the bottom of Page 4 and continues on to Page 6. http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf
3 Medicaid eligibility as of 9/1/2010 may be accessed through this link. The overview was developed using 2011 FPL information. So the income eligibility amounts in the document are lower than they are today. Generally, the FPL has increased by about 3% between 2011 and 2013. http://dhhs.ne.gov/medicaid/Documents/attach3.pdf
4 Poverty guidelines are developed by the U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation. They can be accessed through this link. http://aspe.hhs.gov/poverty/13poverty.cfm
