Medicaid expansion, authorized by the federal government’s Affordable Care Act (ACA), allows people who previously did not qualify to obtain Medicaid coverage. Most states and the District of Columbia have expanded coverage to up to 138% of the federal poverty level (FPL) for single adults without disabilities. The additional federal funding allows millions of people to obtain health care and health insurance who otherwise may not have had that opportunity. Previously, the expansion population experienced a coverage gap, where many of them could not afford private insurance coverage, but earned too much to qualify for any Medicaid program and thus were uninsured.
Medicaid eligibility is predicated on the applicant/enrollee having a low income. Some Medicaid benefits require the enrollee to have a chronic disease or disability, but Medicaid expansion programs do not. They simply provide health care coverage for low-income adults.
ACA Medicaid expansion health benefits include primary care, mental health/behavioral health treatment, substance use treatment, and emergency room coverage. However, it is important to check with your providers to ensure they accept your state’s Medicaid health plan, and to check whether there will be a deductible or a co-pay.
Other Medicaid services not affected by Medicaid expansion include the Children’s Health Insurance Program (CHIP) Traditional Medicaid, waiver programs, and Vendor Medicaid (also known as Nursing Home Medicaid or Long-Term Care Medicaid). Medicare was also not affected by Medicaid expansion. For statistics regarding Medicaid expansion, please visit kff.org; and for information regarding Medicaid applications, visit Medicaid.gov or your state’s Medicaid enrollment website.