WV Center on Budget and Policy > Blog > Family Economic Security > Who Will Qualify for Medicaid Under Expansion?

Who Will Qualify for Medicaid Under Expansion?

With enrollment for the new Health Insurance Marketplace just around the corner and the full implementation of the Affordable Care Act hot on its heels, I wanted to take a moment to consider who will qualify for Medicaid under expansion in West Virginia.

Medicaid is a health program designed to provide comprehensive health and dental insurance for the poor.  These are people who otherwise are most likely uninsured and unable to afford to see a doctor.  Currently, the requirements to qualify for Medicaid in West Virginia are very stringent (Table 1).  Therefore, most Medicaid enrollees are children, the elderly, and the disabled.  A healthy, non-elderly, childless adult cannot qualify for Medicaid in West Virginia under any circumstance, no matter how poor he or she is. 

Last month, however, Governor Tomblin announced that West Virginia would be joining at least twenty other states in expanding the Medicaid program to insure more people.  Beginning on January 1, 2014, the eligibility standards will change significantly.  With the dependent child requirement dropped and increased income limits, virtually any legal resident making less than 138% of the federal poverty level (FPL) will qualify for Medicaid coverage (Table 2).

So what exactly does this mean?  Put simply, a lot more people will gain health insurance.

For example, in 2013 a single mother with one child cannot make more than 35% of the FPL, or $5,429 in a year, to qualify for Medicaid coverage for herself.  To put this in perspective, this mother would have to work less than 15 hours per week at minimum wage ($7.25/hour) to qualify for Medicaid.

However, under the new expansion guidelines, this same mother will be able to earn up to $21,404 in a year and still qualify for Medicaid.  That means she could work a full-time job making more than $10 an hour without having to be concerned about losing health insurance coverage for herself or her child.

Similarly, under today’s eligibility guidelines, a married couple with two children could earn no more than $8,242 to qualify for Medicaid.  Beginning in 2014, they will both be able to work full time making a combined $32,499 and still be eligible for coverage.

The new guidelines will also eliminate the asset test currently required for non-disabled adults and the elderly.  Individuals in these categories with assets that exceed around $4,000 in value, even including cars or retirement savings, may be ineligible for traditional Medicaid coverage, regardless of their income.  Under expansion, these assets will no longer be considered and eligibility will be based strictly on income.

As I’ve discussed before, the costs and benefits of Medicaid expansion in West Virginia go far beyond just federal versus state dollars.  Not only will we see fewer uninsured people, more healthy people, and a healthier, more productive workforce, but we can also expect to see a shift in the incentives that currently keep some people, especially those with pre-existing health conditions, locked in unemployment, and a boost to the state labor market.  

15 Responses to “Who Will Qualify for Medicaid Under Expansion?”

  1. BW Adkins says:

    There is no question that Medicaid expansion in WV will help greatly with there being fewer uninsured people . . .
    But without a greater emphasis and meaningful funding of programs addressing, promoting healthier lifestyles (IE: tobacco cessation, increasing physical activity, adopting healthy diets), this does not necessarily equal a more healthy workforce.

    For example, smoking and other tobacco use cost the State nearly $2 Billion annually in preventable health and occupational costs. Every WV employee who is a smoker costs an average of $4600 in added health/occupational costs each year! One in five deaths in WV are due to cigarette smoking. And those adults who suffer a smoking-related death in WV lose over 14 years of productive work life due to premature death.

    Instead of keeping the price of tobacco products “competitively low” here in WV (WV ranks 44th in tax on cigarettes), the State’s leaders need to consider increasing the tax on all tobacco products, and putting a portion of the revenues generated toward prevention and cessation programs (especially addressing the rural, poor, low socioeconomic population in WV!

  2. Brandon Merritt Brandon Merritt says:

    Thanks for your insight, BW. I think you make a valid point – health insurance alone does not necessarily create healthier people. A person’s health is determined by so many interacting factors (socioeconomic status, where they live, genetics, access to care, behavior) that it would be naive to think that addressing only a single one of them would be sufficient. There’s little argument though that improving access to care by insuring more people will be harmful to one’s health.

    I think you may have some insider knowledge about tobacco use in this state :) and I agree. Stay tuned to WVCBP, you’re likely to see some tobacco tax policy recommendations down the line.

  3. M & D says:

    My partner and I are hoping to get married. But I just recently qualified for Medicaid in WV and am wondering how to find out if getting married might affect my eligibility. Where does one go to find out income restrictions for a married couple w/no kids?

    • Brandon Merritt Brandon Merritt says:

      Getting married could affect your eligibility for Medicaid because it is determined based on household income. If your and your spouse’s combined incomes exceed 138% of the Federal Poverty Level, then you will no longer qualify for Medicaid. For 2014, 138% of the Federal Poverty Level for a household of 2 is $21,707 annually, or $1,809 monthly. If you do exceed that amount and neither you nor your spouse have access to affordable health insurance through an employer, then you would qualify to shop for a health insurance plan on the Marketplace at http://www.healthcare.gov. Based on your income, you and your spouse would likely qualify for tax credits to help purchase a plan on the Marketplace. These tax credits are calculated based on a sliding scale of your income and the cost of the insurance plan that you choose.

      I would recommend you contact your county health and human resources office to inquire about Medicaid eligibility if you have additional questions. In the event that you would no longer qualify for Medicaid, the DHHR office could help direct you to someone who can assist you with getting enrolled in a Marketplace place. Here is a list of county DHHR offices: https://www.wvdhhr.org/bcf/county/

  4. TC says:

    What if you are 67 on Medicare, does the expansion of Medicaid (raising income limits) apply to the Medicare people?

    • Brandon Merritt Brandon Merritt says:

      Medicaid expansion does not apply to seniors on Medicare. However, some low-income seniors can still qualify for Medicaid, which helps offset Medicare premiums and deductibles, based on household income. To be eligible, your household income has to be at or below 100% of the federal poverty level, currently $11,670 per year for an individual ($973/month) or $15,730 for a couple ($1,311/month). If you think you may be eligible or have questions, you can contact the Medicare Helpline at 1-877-987-4463. Hope that helps!

  5. robin says:

    If somebody has expanded medicaid, does their continued coverage depend on an average yearly income or recalculated every month.
    In other words, if your income for one month exceeds qualification, but based on a temporary increase and you know your yearly income will not exceed qualification for expanded medicaid, what happens?

    • Brandon Merritt Brandon Merritt says:

      Hi Robin, thanks for your question. Medicaid eligibility is redetermined every 12 months, unless you report a change of income prior to that. For example, if you begin a new job with a steady monthly income that exceeds Medicaid eligibility, you are required to report your income change to the Medicaid office for a redetermination, in which you will no longer be eligible. However, if your income fluctuates from month to month but you still expect your annual income to be below the eligibility level, then you will need to report that your income is variable and they will determine your eligibility based on your projected annual income.

  6. Bonnie says:

    If you qualify for Medicaid, do you also get all other Benifits? Food stamps, utilities paid rents and such? Or does this only cover health insurance? I know several young people leaving the work force because they say it’s better for them not to work. The job they leave is in health care at $10.00 an hour. They don’t stay long enough to get a raise!

    Thanks.

  7. David Hall says:

    I currently get Medicaid in the state of West Virginia. My partner is moving in with me and they want to apply for Medicaid too. Is it possible for me to keep my Medicaid and for them to apply and obtain it?

    Thanks.

    • Erin Snyder Erin Snyder says:

      David, I am assuming your concern comes from the recalculation of household income. If you are unmarried, your household income will be calculated individually. If both of you qualify for Medicaid based on income guidelines, you both may apply and obtain Medicaid.

  8. Debbie says:

    I currently get regular medicaid in WV. I just started a new job in Md. but I do not know how much I will be making this year as it is a driving job and pays by mileage I drive. The company does offer health insurance but I’m told it is really bad insurance. I have a lot of health conditions that require doctor visits and medications to control. I’m not sure if I should inform Medicaid in Wv. of this or wait until I find out how much I will be making. I cannot afford to pay for meds and dr visits out of pocket?

  9. Mark says:

    My mother currently lives in WV and makes less than $20K a year; gross amount. By the time she pays monthly rent, car insurance, life insurance, utilities, gas to get back and forth to work and food/other basic necessities, she has no money left each month for health care coverage. As she is not yet 65 and was told she makes to much for Medicaid, what other option does she have than to not have health care coverage and keep risking not needing medical assistance? Thank you

  10. Erin Snyder Erin Snyder says:

    Mark, I am sorry that your mother has found herself in a difficult position. Unfortunately, West Virginia is the only state where there is still only one insurer in the marketplace. The element of competition that is meant to bring health insurance costs down is still missing, meaning that insurance is still unaffordable for many. Good news is that there is talk that WV will be adding some insurers, bad news is that doesn’t help your mother for now. She will not have to pay a tax penalty because she qualifies for a “hardship” exemption. There are still several free and income based clinics in the state that could provide her with care and they would be able to offer some additional, better advice for you on moving forward. Here is a link to find information on a clinic in her area: http://www.freemedicalsearch.org/sta/west_virginia

  11. Kristin says:

    My child has been thinking about moving in with my mom when school lets out for the summer, can I still receive a medical card for her if she moves. She will still be living in the same county and I have custody but my moms health isn’t good and my daughter wants to be there incase of an emergency. When/If she moves she will be 17.

Leave a Comment