Article Courtesy of ACA InternationalAbout 5 million people are expected to fall into a "coverage gap" next year in states that are not planning to expand Medicaid under the Affordable Care Act, according to a recent analysis from the Kaiser Family Foundation (http://bit.ly/1gqTaOA). The coverage gap exists for individuals whose incomes will be above the current Medicaid eligibility in their state but below the lower limit for premium tax credits through the health insurance exchanges. The tax credit bottom limits are 100 percent of the federal poverty level in states not expanding Medicaid and 138 percent of the federal poverty level in states that are expanding. The report indicates that 20 percent of people in the coverage gap will be from Texas, which has both a large uninsured population and very limited Medicaid eligibility. Another 15 percent will come from Florida. As of Oct. 22, 25 states have decided to not move forward with Medicaid expansion. The remaining states, as well as Washington, D.C., are expanding their Medicaid coverage to include people earning up to 138 percent of the federal poverty level. The Affordable Care Act initially required states to accept the Medicaid expansion or be penalized by losing existing Medicaid funds, but that provision was deemed unconstitutional by the Supreme Court in June of 2012. This essentially allowed states to opt-out of the expansion. The federal government is proposing to fully pay for expansion through 2016 and then gradually scale back its share to 90 percent. But in states that have rejected expansion so far, leaders have cited concerns over federal funding being reduced, which would increase the financial burden on the states. Even in states not expanding Medicaid, program enrollment is expected to increase next year, according to a separate Kaiser report (http://bit.ly/15PcIp5). Additionally, state-level Medicaid spending in states not expanding coverage is actually expected to increase more than in the states that are expanding coverage. The report noted that this may be because the states that are expanding could save money as new federal dollars replace state dollars
