Study: 5.2 Million Americans Will Fall Into Medicaid 'Coverage Gap'

By Phil Galewitz, Kaiser Health News


About 5.2 million poor, uninsured adults will fall into the "coverage gap," created by 26 states choosing not to expand Medicaid under the federal health law next year, according to a  study released today by the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

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These people are projected to have incomes too high to qualify for their state's existing Medicaid programs, but below the federal poverty level (nearly $11,500 for an individual) required to be eligible for federal subsidies to buy private coverage on the new online insurance marketplaces set up by the Affordable Care Act. Medicaid is the state-federal health insurance program for the poor.

"Millions of adults will remain outside the reach of the ACA and continue to have limited, if any, options for health coverage," the study concludes.

The law provides full federal funding for three years to states that expand Medicaid to cover residents under 138 percent of the poverty level (or just under $15,900 for an individual). But the Supreme Court made that requirement effectively optional for states, and most Republican led-states have opted against expanding the program.

There is no deadline by which states must opt to expand Medicaid, and a few states are still considering it.

Nearly half of the uninsured in the coverage gap live in Texas (1 million), Florida (763,980) and Georgia (409,350) - largely because those states have the most uninsured and limited Medicaid eligibility today.

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Alabama, Mississippi and Louisiana also will be especially hard hit, with more than a third of their uninsured adults falling into the coverage gap next year, the study shows. These states will feel the pinch because they have higher rates of poor uninsured adults and their existing Medicaid programs have some of the nation's tightest eligibility rules. Nationally, about 27 percent of uninsured adults in states not expanding Medicaid will find themselves in that gap, the study said.

The study excludes illegal immigrants because they would not have been eligible for coverage under the law. The study was based on  Census data from 2012 and 2013 as well as on state Medicaid eligibility rules for 2014.

Graphic courtesy of Kaiser Family Foundation.

 

 

 

 

 

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