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Amid Expansion, Some States Trim Medicaid Rolls

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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.

In the other two states, the Medicaid cutbacks are the result of the expiration of federal waivers that allowed for demonstration programs designed to expand coverage. In Vermont, about 19,000 people will fall off the Medicaid rolls as the state ends two such initiatives geared toward helping people with incomes as high as 300 percent of the poverty level, or a little more than $34,000.

Mark Larson, commissioner of the Vermont Department of Health Access, said the programs are ending to save the state dollars since those populations next year can qualify for federal assistance to buy coverage in the state exchange.

Wisconsin would cut more people from Medicaid than any other state as part of a plan advanced by Republican Gov. Scott Walker and still awaiting federal approval. About 92,000 people -- 87,000 parents and caretaker relatives, and 5,000 childless adults with incomes above the federal poverty level -- would lose the Medicaid coverage they previously had as a result of a wavier and be sent to the online insurance marketplace. At the same time, the state is planning to add 100,000 Wisconsin childless adults with incomes below the poverty level to Medicaid.

Fri, Aug 16 2013

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