The health law expanded Medicaid to cover everyone with incomes up to 138 percent of the federal poverty level, or about $15,900 for an individual or $32,500 for a family of four. But the Supreme Court made the expansion optional, and most Republican-led states have decided not to expand. That means more restrictive eligibility rules in those states remain in place.
In South Carolina, adults without children, no matter their income, are not eligible for Medicaid and neither are working parents making more than 89 percent of the federal poverty level (about $17,400 for a family of three) and nonworking parents with incomes over 50 percent of poverty ($9,765 for a family of three).
Several factors explain why some states expect higher growth in the program than others.
Several, including South Carolina, are taking a more aggressive approach to finding people who are currently eligible, said Robert Damler, a principal with consulting firm Milliman.
States have also made different assumptions about how many people who are now eligible but not enrolled will come into the program.
"Some states assumed a lot of new uptake, others essentially assumed that since they weren't expanding eligibility, that the current trend of relatively slow growth would continue," said Vernon Smith, managing principal at consulting firm Health Management Associates in Lansing, Mich.
The law also makes it easier to apply because of the new online insurance marketplaces that will determine if people qualify, the elimination of asset tests and other policy changes such as no longer counting child support toward income.
The widely varying eligibility standards among states will also have a key impact on growth.
Some states that are expanding under the law, such as New York and California, already have broad eligibility levels so they have fewer people to add to the Medicaid rolls.
Overall states that will not expand eligibility next year project a 5 percent jump in enrollment, according to a recent study by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured. (KHN is an editorially independent program of the foundation.
Fri, Nov 22 2013