11.5 Million Poor Uninsured Americans Could Be Eligible for Medicaid if States Opt for ACA Expansion
In June of 2012, the Supreme Court ruling on the Affordable Care Act (ACA) put the decision to expand Medicaid coverage to nonelderly adults with incomes below 138 percent of the federal poverty level (FPL) in the hands of the states. With January 2014 approaching, it is clear that many states do not plan to use the ACA to expand Medicaid coverage by then. Nationwide, state decisions about expanding Medicaid affect an estimated 11.5 million poor uninsured adults with income below the FPL. These poor uninsured adults would miss out on Medicaid if their state does not expand the program and would not be eligible to receive any subsidies for obtaining health insurance coverage through the exchanges under the ACA.
The accompanying map provides estimates of the number of poor uninsured adults who would be eligible for Medicaid only if their state expands the program under the ACA. Additional data show the racial and ethnic and age distribution of these individuals in each state. These estimates are derived from Urban Institute tabulations of the 2010 American Community Survey that take into account income, immigration status and other factors that determine eligibility and reflect current Medicaid eligibility requirements for adults in each state. States are categorized into two groups: expanding Medicaid under the ACA; and not expanding Medicaid under the ACA by January 2014. Iowa and Michigan are classified as Medicaid expansions, but will require waiver approval and, as such, will not be in place by January 2014. This classification is based on information presented on the Centers for Medicare and Medicaid Services (CMS) website that reflect state decisions and CMS actions as of September 30, 2013 and recent reports indicating that Ohio will be expanding Medicaid.
Based on current information, an estimated 4.9 million poor uninsured adults will become newly eligible for Medicaid because 25 states and the District of Columbia have opted to expand Medicaid; and 6.6 million will not be eligible because they live in one of the 25 states that will not be expanding Medicaid by January 2014. If states make choices that change how they are characterized in this map, we will be updating this picture to keep it as current as possible.
State plans for expanding Medicaid under the ACA