Medicaid Expansions

The ACA will expand access to affordable health insurance for millions of Americans. In states that choose to implement the Medicaid expansion for low-income adults, Medicaid will provide an important new pathway to coverage. Yet, even in states that choose to expand Medicaid a significant proportion of the low-income nonelderly adult population will be excluded from the Medicaid expansion due to their immigration status. This brief provides the first state-specific estimates of the number of uninsured low-income adults that will potentially be excluded from the Medicaid expansion because of their immigration status.

This report provides updated estimates in light of Arkansas's recently proposed option for covering low-income adults through private health plans in the state insurance exchange. These estimates find that the private option can be fully funded with existing resources at the state level and would add less than 15% to federal health-care costs in Arkansas. In some realistic scenarios, there could be no additional federal costs at all.

The ACA expands Medicaid significantly beginning in 2014 and the expanded program is to serve as the foundation of the broader framework created by the ACA to cover millions of previously uninsured low-income adults and children. This primer examines how the Medicaid program is structured, who it covers, what services it provides, how it is financed, how much it costs, and how it will change under the ACA. 

On February 28th, 2013, Politico reported that Arkansas Governor Mike Beebe had received approval “to take federal Medicaid expansion money and use it to buy private health coverage for low-income residents through the state’s insurance exchange.” This brief explains the legal basis for this decision, as well as the issues that can be expected to arise in using this approach to coverage.

Under the Affordable Care Act (ACA), there will be several changes to the Medicaid enrollment process in efforts to simplify it, including a single streamlined application. This report examines the propose paper-based application and 85 current printable Medicaid and CHIP applications, focusing on availability of application assistance, language accessibility, verification of income, verification of citizenship and immigration status and other messages for immigrant families, medical support requirements, and disability screening questions.