This article first appeared in the St. Louis Beacon, Oct. 22, 2013: By Missouri’s refusal to expand its Medicaid program, more than 193,000 adults in the state will find themselves stuck in a coverage gap, come Jan. 1.
These are uninsured adults who make too much money to qualify for Medicaid but too little to be eligible for the government subsidies that discount the price of private health insurance.
Starting on Jan. 1, the Affordable Care Act promised a new standard of Medicaid eligibility for the poor, offering comprehensive health benefits to Americans with incomes of up to 138 percent of poverty or roughly $19,500 for a family of three.
But this health benefit will elude more than 5.1 million adults, according to data from the Kaiser Family Foundation. That's because they reside in one of the 26 states, including Missouri, that chose not to expand Medicaid. Among the 26 non-participting states, Texas has the largest gap, affecting more than 1 million residents, while the smallest gap is in Alaska, affecting more than 17,000 people.
Adult eligibility for Medicaid is very limited in states not expanding Medicaid. In Missouri, the median eligibility level of adults is only 24 percent of poverty – meaning a family of three must have a household income of less than $5,000 a year. Only Alabama and Texas have eligibility limits lower than Missouri, while Indiana and Louisiana have limits similar to Missouri, according to Kaiser.
In Missouri, people in the coverage gap represent 30 percent of uninsured adults, compared to a nationwide average of roughly 25 percent of uninsured adults in all states that have refused to expand Medicaid. The numbers rise when broken down to include only adults with incomes below 139 percent of poverty. In that case, more than 61 percent of Missouri’s Medicaid-targeted population end up in the coverage gap. Some of those Medicaid-eligible residents will be eligible for ACA tax subsidies if their incomes are above 100 percent but under 139 percent of poverty.
The number in the gap is substantially higher when adjusted to reflect only adults with incomes below 100 percent of poverty – or roughly $11,400 for a single-person household. According to Kaiser’s figures, this group represents approximately 168,000 adults or more than 87 percent of the poor uninsured adults in Missouri.
Unless the Missouri Legislature expands Medicaid in the next session, this group will have no health insurance at a time when federal hospital subsidies to provide care for them are being curtailed because the federal government gave states the option to expand their Medicaid programs to insure them.
The federal government has said it will pay the full cost of Medicaid expansion for the first three years, between 2014 and 2016, with the states required to pick up no more than 10 percent of the cost in subsequent years.
