Health Care Reform: Medicaid Q&A

Health Care Reform: Medicaid Q&A

by Posted on: September 30, 2014Categories: HR & Compliance   

Medicaid provides the foundation of health coverage for low-income individuals under the Affordable Care Act (ACA).

Expansions to Medicaid under the ACA include establishing a national floor for coverage, eliminating the exclusion of adults without dependent children from coverage and providing states increased federal resources to fund the expansion of Medicaid.

Who is eligible under the reform legislation?

The ACA bases eligibility for Medicaid on income without regard to previous restrictions for individuals under the age of 65. The law also establishes a national floor for Medicaid coverage, set at 133 percent of the federal poverty level (FPL) starting in 2014. These changes are aimed to reduce variations in eligibility for Medicaid between the states and to include adults under 65 without dependent children—a population not previously eligible for the program.

Subsidies for coverage for individuals with incomes above Medicaid levels, between 133 percent and 400 percent FPL, will be available through the state-based exchanges. Not all states are choosing to expand their Medicaid programs; you can visit to see whether your state has expanded Medicaid coverage. Individuals who are eligible for Medicaid will not be eligible for coverage subsidies in the state-based exchanges.

What if I’m eligible for Medicaid now?

Those individuals who were eligible for Medicaid as of the date the legislation was passed, March 23, 2010, continue to be eligible for coverage.

What will Medicaid cover?

The legislation provides that Medicaid will cover at least the minimum essential health benefits available in the state-based exchanges. At this time, the law also suggests that states have the option to establish a benchmark plan that would serve as the minimum essential health benefits and would provide a more comprehensive benefits package, similar to what is currently offered under Medicaid.

For high-need populations, Medicaid will continue to cover services such as transportation, medical equipment, habilitation services and case management that may not otherwise be covered under a typical private plan. The elderly and those with disabilities will continue to receive a more extensive Medicaid package that will also include long-term care benefits. The legislation includes financial incentives to encourage states to offer preventive services with no cost-sharing to better implement care for those with chronic conditions and to expand community-based long-term care.


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