Where are States Today? Medicaid and CHIP Eligibility Levels for Children and Non-Disabled Adults as of April 1, 2014
As part of the Affordable Care Act’s goal to reduce the number of uninsured, it makes several key changes in Medicaid eligibility. As enacted, the ACA expands Medicaid to nearly all individuals with incomes at or below 138% FPL ($16,104 for an individual or $27,310 for a family of three in 2014) beginning as of January 2014. However, this expansion was effectively made a state option by the Supreme Court ruling on the ACA. A total of 27 states, including DC, are currently implementing the ACA Medicaid expansion in 20141. There is no deadline for states to adopt the expansion, and several states are still actively considering the option. The ACA also established new streamlined eligibility and enrollment processes for Medicaid, which all states must implement regardless of their Medicaid expansion decisions. These new streamlined processes include a change in how financial eligibility is determined for many Medicaid beneficiaries to be based on Modified Adjusted Gross Income (MAGI). This change is designed to standardize the approach to determining financial eligibility across states as well as health insurance affordability programs. As part of the transition to use of MAGI, states converted their existing Medicaid income limits to MAGI-equivalent limits. Based on data released by CMS, this brief provides an overview of Medicaid and CHIP eligibility levels for non-disabled children and adults across states as of April 1, 2014, reflecting state Medicaid expansion decisions and the conversion to MAGI-based limits.2
Medicaid and CHIP coverage for children remains strong across states. As of April 1, 2014, more than half of the states (29, including DC) cover children in families with incomes at or above 250% FPL and 19, including DC, cover children in families with incomes at or above 300% FPL (Figure 1, Table 1 -1A). Moreover, as of April 2014, 18 states that previously covered older children up to 133% FPL in separate CHIP programs now provide coverage for these children in Medicaid, as the ACA established a minimum Medicaid eligibility level of 138% FPL for all children up to age 19.3 With the exception of Arizona, CHIP enrollment is open in all states. The ACA preserves this base of children’s coverage by requiring states to maintain eligibility and enrollment policies in place at the time the ACA was enacted (March 23, 2010) until September 30, 2019 for children in both Medicaid and CHIP.
Most states continue to cover pregnant women in Medicaid and CHIP above the federal minimum standards. Prior to the ACA, states were required to cover pregnant women in Medicaid to at least 133% FPL, although most states had expanded beyond this minimum and have maintained this coverage in 2014. As of April 1, 2014, 30 states, including DC, cover pregnant women at or above 200% FPL (Figure 2, Table 2-2A). However, the ACA requirement to maintain coverage for pregnant women ended on January 1, 2014 and three states (LA, OK, and VA) have since reduced eligibility levels for pregnant women.
The Medicaid expansion significantly increased eligibility for adults in the 27 states implementing the expansion. Prior to 2014, 15 of the 27 states implementing the Medicaid expansion already covered parents at or above the poverty level through Medicaid, but only nine (9) states provided full Medicaid coverage to adults without dependent children. In the states implementing the Medicaid expansion in 2014, eligibility levels increased for parents in 16 states and for childless adults in 24 states. Overall, in these states, the median eligibility threshold for parents rose from 106% in January 2013 to 138% FPL as of April 2014, while the median threshold for childless adults jumped from 0% to 138% FPL. As of April 2014, three (3) states (CT, DC, and MN) cover parents above 138% FPL and two (DC and MN) cover childless adults above this level.
Many poor adults remain ineligible for coverage in the 24 states not expanding Medicaid at this time. As of April 2014, eligibility levels for parents are below poverty in 20 of these states and below half of poverty in 12 states (Figure 3, Table 3-3A), and childless adults generally remain ineligible for Medicaid at any income level (Figure 4, Table 3). Overall, among the 24 states not implementing the Medicaid expansion at this time, the median eligibility level for parents is just 49% FPL, with only four (4) states (AK, ME, TN, and WI) covering parents with incomes at or above poverty. Only Wisconsin is providing full Medicaid coverage to adults without dependent children. Parents and other adults with incomes above these limited Medicaid eligibility levels but below 100% FPL fall into a coverage gap; they remain ineligible for Medicaid but do not earn enough to qualify for the premium tax credits for new Marketplace coverage. This gap leaves nearly five million uninsured adults without a new coverage option.4
In sum, as of April 2014, Medicaid coverage for adults significantly increased in the 27 states implementing the Medicaid expansion and eligibility levels for children and pregnant women remain strong across states. As such, the Medicaid expansion offers the potential to significantly reduce the number of uninsured. However, in contrast to gains in states expanding Medicaid, large coverage gaps remain in states that are not expanding, leaving millions of poor uninsured adults without access to a new coverage option.
New Hampshire plans to implement the Medicaid expansion in July 2014. Indiana and Pennsylvania have pending waivers for Medicaid expansion plans would be implemented post 2014.
Based on data from the Centers for Medicare and Medicaid Services (CMS), State Medicaid and CHIP Income Eligibility Standards Effective April 1, 2014.
While the new minimum eligibility threshold is 133 percent of the FPL, the standard five percentage point of the FPL disregard is included to represent the highest threshold at an individual may be eligible for Medicaid.
For more information, see: Kaiser Commission on Medicaid and the Uninsured, “The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid.” Updated April 2014.