January 20, 2015 -- States have broadened Medicaid coverage dramatically in the past decade, particularly as 27 states and the District of Columbia expanded coverage to adults last year under the health care law, according to a new report by the Georgetown Center for Children and Families and the Kaiser Family Foundation. But in almost all of the 23 states that did not broaden coverage as the health care law allows, adults who don't have children rarely qualify for Medicaid, no matter how low their income is.
The health care law (PL 111-148, PL 111-152) allows states to expand coverage to people with income up to 138 percent of the federal poverty level under Medicaid, the federal and state partnership for the poor. The poverty level is $11,670 for an individual or $19,790 for a family of three.
States that do not expand Medicaid typically set different eligibility criteria for parents and childless adults. The report found that in January 2015, Wisconsin was the only state that didn't expand eligibility for childless adults. The 29 states covering childless adults is up from seven states in 2011 and 25 states in January 2013.
Over the past two years, the number of states covering parents with income at or below the poverty line rose from 18 states in January 2013 to 31 states in January 2015.
Even before the health care law's Medicaid expansion was implemented last year, many states had widened coverage for children over the past couple of decades as the Children's Health Insurance Program was implemented. In 1997, only six states covered children in households with income that is twice the federal poverty level. That number rose to 41 in 2005 and 48 in 2015. The number of states covering children in families earning three times the poverty level rose from two in 1997 to six in 2005 and 19 in 2015.
Despite those coverage gains, in most of the states that haven't expanded Medicaid under the health care law, adults without kids remain out of luck, and parents only qualify if they are very poor. The report found that 14 states set eligibility levels for non-parents at less than one-half of the poverty level.
Parents can only get Medicaid in Alabama if their household income is 18 percent of the poverty level or less, the report said. That's just under $3562.20 per year for a family of three. In Texas, parents qualify if their income is 19 percent of poverty or $3760.10, or less.
And people who earn too much for Medicaid may not make enough to qualify for new federal subsidies available to buy insurance through new health insurance marketplaces. People can only get the subsidies if their income is between the poverty level and four times the poverty level. That leaves almost four million uninsured people without any way to get federal help in getting coverage either through Medicaid or the marketplace plans, according to other Kaiser Family Foundation reports.