We spend so much time talking about the PPACA and Medicare, it’s possible that Medicaid doesn’t get enough attention.  It’s worth a review.

Basically, Medicaid is supposed to provide health care coverage for the poorest among us.  There are some minimal federal guidelines that are set for Medicaid.  Then, each state gets to implement it as it sees fit.  Some states are more generous, and some less.  Generally, Medicaid is meant to cover those at the low end of the socioeconomic spectrum.  The government defines poor this way:

Persons in Family2009-2010 Poverty Level

While you consider the table, remember this amazing fact – a single parent, with a child, who makes minimum wage earns MORE than the poverty level.  That’s how low the line is.

Regardless, Medicaid must cover:

  • Kids under 6 years of age to 133% FPL
  • Kids 6-18 to 100% FPL
    • SCHIP upps these to 300% FPL in most states
  • Pregnant women up to 133% FPL
  • Parents to 1996 welfare levels
  • The elderly and those with disabilities who receive SSI

Now, states get to implement things above that as they see fit.  But the first important thing to note is that adults without children aren’t mentioned at all.  And in most states, they can’t get Medicaid.

Let me say that again – in most states even the poorest adults without children don’t get Medicaid.

And it gets worse.  Those 1996 welfare levels can be super low.  So low that, for instance, in Alabama a couple with two children making $2500 $5300 a year doesn’t qualify for Medicaid.  Granted, some states are more generous.  But in many, parents have to be very, very poor in order to get Medicaid.

One of the overlooked benefits of health care reform is that it sets guidelines that vastly increase Medicaid coverage nationally.  The federal rules will change such that everyone, even those without children, making 133% FPL get Medicaid.  In some states, that might not be a big deal.  But for those in the states with the least coverage, this would result in millions of the poorest among us getting the coverage that many of us already assume they get.

I bring this up because of what’s going on in Arizona. Recently, Governor Brewer asked HHS Secretary Sebelius for permission to drop 280,000 people from Medicaid coverage. Most of them (250,000) are adults without children, and as I said above, states don’t have to cover them at all. Technically, Arizona could drop those 250,000 and still meet the minimum standards I listed above.  They were allowing “extra” people on Medicaid. She thought she had to ask for permission, however, because the PPACA has a provision that does not allow them to reduce coverage below what it is now.

It turns out that, because of a technicality, Arizona doesn’t need permission. They had increased coverage to those childless adults on a “demonstration waiver“, which wasn’t permanent, and thus they can go ahead and drop them.

I can’t figure out if this is a win for Gov. Brewer or the administration, but I sure know who loses: 250,000 poor people in Arizona who are suddenly going to be without health insurance coverage. 2014 can’t come soon enough for them.

UPDATE: Although my original link to a NYT article showed the parental limit in Alabama to be 11% of the FPL, a more recent link shows that it is now 24%. As always, I aim to be accurate, so I corrected the number; I don’t think this changes the message of my post at all.

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