States that expanded Medicaid under the Affordable Care Act (ACA) have seen significant gains in coverage eligibility, widening the divide between those states that have resisted expansion.
Since 2013, median Medicaid eligibility has jumped from 61% to 138% of the federal poverty level among states that elected to expand the health program, according to a Kaiser Family Foundation survey. That means a family of three with an annual income of $28,676 is eligible for coverage in their state, compared to five years ago when median income level was nearly $17,000 less.
Likewise, children eligible for the Children’s Health Insurance Program (CHIP) has increased, with all but two states covering children with incomes up to at least 200% of the poverty level.
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There’s a stark contrast with the 19 states that have not impended Medicaid expansion, where 11 states limit parent eligibility to just over $10,000 a year. Texas and Alabama represent the lowest limits, according to the KFF survey. In those two states, families that make more than $3,740 a year are ineligible for Medicaid coverage.
Moving forward, Medicaid coverage depends largely on whether those states elect to expand their program. In Maine, for examples, voters passed a ballot initiative in November to expand the program, but implementation has run up against resistance from the governor.
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Additionally, new work requirements could add complexities to the enrollment process. Although states have made notable IT investments to streamline renewals and modernize the enrollment process by building in real-time eligibility determinations, recently approved waivers incorporating new coverage restrictions could add a layer of “complex documentation and costly administrative processes,” according to KFF.
Federal funding cuts to the program, backed by the Trump administration and some congressional leaders, could also negate coverage gains over the last several years or stymie state interest in Medicaid expansion.