What is the difference between Medicaid and expanded Medicaid?
Asked by: Kayleigh Jones | Last update: September 7, 2025Score: 4.8/5 (3 votes)
What is the downside 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.
What are the four types of Medicaid?
- State-operated fee-for-service (FFS)
- Primary care case management (PCCM)
- Comprehensive risk-based managed care (MCO model)
- Limited-benefit plans.
What is the income limit for Medicaid expansion?
The Affordable Care Act (ACA) permits states to expand Medicaid coverage to adults with incomes up to 138 percent of the poverty level (about $20,780 annually for an individual or $35,630 for a family of three). States that have adopted the expansion have dramatically lowered their uninsured rates.
What are the different types of North Carolina Medicaid?
- AmeriHealth Caritas North Carolina, Inc. – Prepaid Health Plan; Statewide.
- Healthy Blue of North Carolina – Prepaid Health Plan; Statewide.
- UnitedHealthcare of North Carolina, Inc. – Prepaid Health Plan; Statewide.
- WellCare of North Carolina, Inc. – ...
- Carolina Complete Health, Inc. –
Medicaid, explained: why it's worse to be sick in some states than others
Is North Carolina expanded Medicaid?
North Carolina expanded health care coverage to more people.
On December 1, 2023, NC Medicaid expanded to cover people ages 19 through 64 up to 138% of the federal poverty line. That's about $1,730/month for singles and $2,970/month for families of three.
What does Medicaid not cover?
Though Medicaid covers a wide range of services, there are limitations on certain types of care, such as infertility treatments, elective abortions, and some types of alternative medicine. For example, the federal government lists family planning as a mandatory service benefit, but states interpret this differently.
What is the difference between Medicaid and Medicaid expansion?
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.
How much can you make and still get Medicaid in NC?
Under the expanded eligibility guidelines, Medicaid is available in North Carolina to a single adult with annual income up to about $20,782 in 2024 (this is 138% of the federal poverty level), and to adults in a family of three with a household income up to about $35,631/year.
How often does Medicaid check your bank account?
Medicaid agencies can check your account balances for bank accounts at any financial institution you've used in the past five years. They will check when you submit an application and on an annual basis, but checks can occur at any time.
What happens if you make too much money while on Medicaid?
If you're over the Medicaid income limit, some states let you spend down extra income or place it in a trust to help you qualify for Medicaid. If you receive long-term care but your spouse doesn't, Medicaid will allow your spouse to keep enough income to avoid living in poverty.
Will I lose my Medicaid if I get Medicare?
People who have both Medicare and full Medicaid coverage are “dually eligible.” Medicare pays first when you're a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have.
What 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.
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.
Is Medicaid expansion expensive?
State officials estimated that expansion would be accompanied by a price tag of nearly $55 billion by 2023, but actual costs have surpassed $203 billion—a cost overrun of 271 percent.
Does NC Medicaid check your bank account?
Upon applying for Medicaid, the program conducts an initial financial assessment. This assessment thoroughly reviews your financial status and bank accounts to determine if you meet the asset and income criteria.
What are the income limits for expanded Medicaid?
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.
Which state has the best Medicaid program?
The top states—ranked from 1 to 10—are Massachusetts, Nebraska, Vermont, Alaska, Wisconsin, Rhode Island, Minnesota, New York, Washington, and New Hampshire.
What are the disadvantages of having Medicaid?
- Lower reimbursements and reduced revenue. Every medical practice needs to make a profit to stay in business, but medical practices that have a large Medicaid patient base tend to be less profitable. ...
- Administrative overhead. ...
- Extensive patient base. ...
- Medicaid can help get new practices established.
Is everything free with Medicaid?
States can impose copayments, coinsurance, deductibles, and other similar charges on most Medicaid-covered benefits, both inpatient and outpatient services, and the amounts that can be charged vary with income. All out of pocket charges are based on the individual state's payment for that service.
What is exempt from Medicaid?
Certain types of income, such as Supplemental Security Income (SSI), veteran's benefits, and some forms of child support, are exempted from the spend down calculation. These exemptions ensure that individuals with limited income sources can still qualify for Medicaid.