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Health Care Reform:

Health Insurance & Affordable Care Act

Amid Expansion, Some States Trim Medicaid Rolls


About 10,000 childless adults in the state, a little less than a third of those losing Medicaid coverage, won't qualify for those federal subsidies because they have incomes below the poverty level, $11,490 for an individual. The health law makes those subsidies available only to people with incomes between the poverty level and four times that amount. The law was written that way because it was assumed all states would expand Medicaid eligibility to cover everyone with incomes up to 138 percent of the poverty level, but the Supreme Court last year made that provision optional. Only about half the states are expanding Medicaid for 2014. Many states led by Republicans have balked at expanding Medicaid, citing how spending for the program has outpaced inflation and even a modest increase in spending over the next decade could be difficult.

Stacey Jacobsohn, 52, of Augusta, Maine, is worried about losing her Medicaid coverage particularly since she had a stroke last year. With a $5,000 annual income, she said she will have to rely on her doctors to cut their prices so she can keep seeing them. "It's going to be very hard for me," she said. "It's a lot of fear right now."

For the past four years, states have been limited in their ability to reduce the size of their Medicaid programs because of a requirement called "maintenance of effort," which first took effect in the 2009 federal stimulus law that provided billions of dollars to states during the recession as long as they didn't restrict standards for eligibility. That restriction was extended in the 2010 Affordable Care Act. But that provision ends for adults in 2014. That's why Maine next year will be able to reduce its Medicaid coverage for childless adults. In addition, Maine next year plans to reduce eligibility for parents and caretakers from 133 percent of the poverty level to 100 percent of the poverty level, which affects 15,000 adults.

Maine Gov. Paul LePage, a Republican, says his state can't afford its current Medicaid program nor take on an expanded one, even if all the costs are paid for the first three years by the federal government. LePage this year vetoed a measure passed by the legislature to expand Medicaid under the health law's provision. Supporters of the measure could not get enough votes to override his veto. "Adding non-disabled individuals to our welfare program when we are failing to provide core services to thousands of disabled and elderly Mainers is unacceptable," LePage said in his veto message.

Fri, Aug 16 2013

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