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Amid Expansion, Some States Trim Medicaid Rolls

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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.

"The governor's reforms balance the need to maintain a strong and sustainable health care safety net with ensuring the greatest number of people possible can afford to remain in the private health insurance market and maintain their independence," according to a statement by the Wisconsin Department of Health.

Many of the 92,000 Wisconsin adults losing Medicaid coverage already pay small monthly premiums. It's unclear how much those rates will increase in the online marketplace.

"The products designed for the marketplace were never designed for people in these low-income categories," said Donna Friedsam, health policy program director at the University of Wisconsin. "Even with the federal subsidies, the cost sharing will still be quite onerous."

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.

Fri, Aug 16 2013

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