Juliette Mullin, Editor
As originally written, the Affordable Care Act (ACA) would have made every American under 138% of federal poverty level (FPL) eligible for Medicaid. It also would have downsized special Medicaid assistance for safety-net hospitals starting this year.
The reality is proving much more complicated.
Who is eligible for Medicaid in each state this year?
The Supreme Court ruling on the ACA put the decision to expand Medicaid in the hands of state legislators. Although observers widely expected the majority of states—even Republican ones with governors who took a tough stance against the ACA—to ultimately expand the program, 24 states have yet to do so.
Interactive map: Which states have opted out of the expansion?
As a result, Medicaid eligibility for 2014 is much more confusing than originally planned. To make matters a little simpler, CMS has made available a set of fact sheets with state-by-state eligibility levels as of Jan. 1, 2014.
The charts illustrate major variation in health coverage access for low-income residents.
In all states that have expanded Medicaid, individuals are eligible for Medicaid if they make less than 138% FPL. (Why do we say 138% instead of 133%? Get primed.) The eligibility level applies regardless of age or parental status, meaning it applies to childless adults as much as it does to children, parents, and pregnant women.
But in 15 of the states that are not expanding Medicaid, childless adults do not qualify for Medicaid, regardless of their income level. And in many non-expanding states, only the poorest parents get Medicaid coverage. According to the fact sheet, parents in Alabama have the lowest eligibility threshold in the country: They must make 13% FPL or lower to qualify for Medicaid. That's an income of about $124 per month, according to CMS.
Meet the five million Americans caught in the ACA coverage gap
Not just eligibility: Congress changes the ACA's DSH cut schedule
To offset the cost of the Medicaid expansion, the ACA was supposed to halve the Medicaid disproportionate-share payment program by fiscal year (FY) 2020. Those cuts were supposed to start in FY 2014.
The Supreme Court's ACA ruling changed things. It meant that hospitals in states that do not expand Medicaid would lose DSH funding without benefiting from an influx of new Medicaid patients.
Unsurprisingly, this caused a lot of anxiety for hospitals. They lobbied for a reprieve, and the 2014 budget deal delayed the cuts to FY 2016 (but doubled the amount of reductions that hospitals will face in the first year of cuts.)
The "doc fix" deal that President Obama signed into law last week further pushes back these cuts, delaying them until FY 2017 and adding a year of cuts to the reduction schedule.
A Law Delayed: What other ACA provisions have changed?
We chart out the changes to the Affordable Care Act's coverage expansion timeline.
Get the infographic now.