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.  

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