Medicaid Expansion, Medicaid Gap, and Vulnerable Populations

Medicaid is the nation’s most significant insurance system for low-income populations covering about 68 million individuals.  The Affordable Care Act (ACA) expanded Medicaid eligibility to individuals with incomes below 138% of the federal poverty level. Beginning in 2014, coverage for the newly eligible adults would be fully funded by the federal government for three years phasing down to 90% by 2020. 

Although the initial intent of the expansion of Medicaid was to be national, as a result of a Supreme Court decision known as National Federation of Independent Business v. Sebelius, nineteen states opted out of the program, with three states still undecided on the expansion.  The ACA’s Medicaid expansion now covers 9.7 million people in states that participate in the expansion, instead of the 17 million as originally planned.  Furthermore, in states not expanding, more than four million fall into what is called the “Medicaid Gap” where individuals are considered too wealthy to receive Medicaid and too poor to receive federal subsidies for purchasing insurance from the exchanges.

The goals of this presentation are to provide public health nurses with comprehensive profiles of ACA’s Medicaid expansion and the unintended Medicaid Gap and to analyze how the nineteen states’ decision to opt out of Medicaid expansion impacts vulnerable groups.  To this end, analyses of not expanding Medicaid will include the impact on the poor, ethnic minorities, women, and rural people.  Long-term policy implications will be discussed.