What happens if Medicaid is not expanded?
Asked by: Kailyn Kris | Last update: July 24, 2025Score: 4.7/5 (28 votes)
What does it mean to not expand Medicaid?
If your state hasn't expanded Medicaid, your income is below the federal poverty level, and you don't qualify for Medicaid under your state's current rules, you won't qualify for either health insurance savings program: Medicaid coverage or savings on a private health plan bought through the Marketplace.
Why does Medicaid need to be expanded?
Medicaid expansion is associated with improvements in overall self-reported health among adults with low incomes. Among people with chronic disease, it is associated with improved access to care, better health outcomes and disease management, and decreased mortality.
How does Medicaid expansion affect state budgets?
A study that analyzed budget data from all 50 states from 2010-2018 comparing changes in each category of spending between Medicaid expansion states vs. non-expansion states found that Medicaid expansion increased total spending in expansion states by 6% to 9%, compared to non-expansion states.
What are the negative effects of Medicaid expansion?
KEY FINDINGS. More than 5.8 million Americans would be forced off private insurance and onto welfare if the remaining states were to expand Medicaid. This crowd-out alone would exceed $8 billion. Expansion has harmed hospitals and providers, forcing millions off private insurance and onto welfare, which pays less.
Implications of State Decisions to Expand or Not Expand Medicaid
Who benefits the most from Medicaid expansion?
Expanding Medicaid helps low-income families' health and financial well-being, especially those in which someone has lost a job. In states that expanded Medicaid under the Patient Protection and Affordable Care Act (ACA), unemployed workers experienced large gains in coverage.
Does Medicaid check your income every year?
Yes, income and assets have to be verified again for Medicaid Redetermination. After initial acceptance into the Medicaid program, redetermination is generally every 12 months. The redetermination process is meant to ensure the senior Medicaid beneficiary still meets the eligibility criteria, such as income and assets.
How does Medicaid check your bank account?
Medicaid agencies can and will look at your balance from any bank account you've had in the last five years and they may also conduct property checks using public records. To track of all of this information and annually update and confirm it, New York's Medicaid program uses an Asset Verification System (AVS).
How often does Medicaid reevaluate?
Medicaid Renewal for seniors and individuals with disabilities must occur at least every 12 months. A state may choose do redeterminations more frequently, but generally speaking, Medicaid Redetermination is limited to once a year.
Which states haven't expanded Medicaid?
The Affordable Care Act, also known as Obamacare, was enacted in 2010, but 10 states have not expanded Medicaid, the federal-state program that provides health care for low-income people. They are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.
What is the difference between Medicaid and expanded Medicaid?
Under the expansion guidelines, Medicaid eligibility is extended to adults under age 65 with incomes up to 138% of the federal poverty level/FPL (133% plus a 5% income disregard). Pre-ACA, Medicaid was generally never available to non-disabled adults under age 65 unless they had minor children.
What is the highest income to qualify for Medicaid 2024?
Parents of Dependent Children: Income limits for 2024 are reported as a percentage of the federal poverty level (FPL). The 2024 FPL for a family of three is $25,820. Other Adults: Eligibility limits for other adults are presented as a percentage of the 2024 FPL for an individual is $15,060.
Why was I taken off Medicaid?
Some are still eligible for Medicaid but may lose coverage for administrative reasons, including not having a current address on file, submitting an incomplete renewal application, not applying for a renewal, or submitting a late application.
How much does Medicaid expansion cost?
Per-enrollee spending in states that expanded Medicaid was higher for all eligibility groups than in non-expansion states (Figure 4). Expansion states spent on average $8,116 per enrollee – over $2,000 more per enrollee when compared to non-expansion states, which spent $5,988 per enrollee (Figure 4).
What happens when you are on Medicaid and turn 65?
Therefore, following the ACA's coverage expansion, many newly-insured older enrollees will face a complex insurance transition on their 65th birthday: they will lose Medicaid coverage and transition from Medicaid to Medicare as their primary insurer.
How can I protect my money from Medicaid?
A Medicaid Asset Protection Trust is exactly as it sounds—a trust designed to protect assets from being counted for Medicaid eligibility. An MAPT allows a person to qualify for long term care benefits from Medicaid, while protecting assets from being depleted if long-term care is needed.
How does Medicaid investigate?
The MFCU may obtain records by subpoena or search warrant, but most often such collection of evidence is accomplished by a written request in the form of a letter. If you receive a record request, it may be that you are a target of an investigation, or your records are needed for other evidentiary reasons.
What happens if you win money while on Medicaid?
Winning the lottery generally doesn't require you to pay back Medicaid costs. However, it can affect your eligibility for Medicaid, as eligibility often depends on income levels, which vary by state. You might lose your benefits if your lottery winnings push your income above the Medicaid threshold.
Do you have to pay back Medicaid if you get a job?
No. Unlike employer-sponsored plans, Medicaid is not tied to your job. You'll still have it even if you lose your job because of COVID-19 or for any other reason. If you find a job, your new financial situation will determine whether you qualify for Medicaid.
Do you have to report all income to Medicaid?
Yes. Some forms of income that are non-taxable or only partially taxable are included in MAGI and affect financial eligibility for premium tax credits and Medicaid.
What is the downside of Medicaid expansion?
The cost of expansion has far exceeded original estimates. States are on the hook for much more than they bargained for. In the states that have expanded, the program covers twice as many people and costs 76% more per enrollee than initially projected. Many of these additional enrollees may be ineligible for Medicaid.
What are the downsides of Medicaid?
Disadvantages of Medicaid
One of the primary reasons for this is that Medicaid reimbursements are lower than those of commercial insurers for most procedures and treatments.
How many states have not expanded Medicaid?
To date, 41 states (including DC) have adopted the Medicaid expansion and 10 states have not adopted the expansion. Current status for each state is based on KFF tracking and analysis of state expansion activity. These data are also available in a table format. The map may be downloaded as a Powerpoint.