By Stacy Collins, MSW
Associate Director, Health Reform Implementation; AMCHP
Traditionally, Medicaid coverage has been limited to pregnant women, young children and disabled and elderly adults. Through the Affordable Care Act (ACA), states have the option to expand Medicaid coverage to all adults with incomes at or below 138 percent of the federal poverty line (FPL). The federal government pays 100 percent of the cost of the expansion through 2016, dropping to 90 percent by 2020 and remaining at that level thereafter.
As of May 2016, 19 states have chosen not to accept federal funding to expand Medicaid coverage to very low-income adults. Nearly three million uninsured Americans in these states fall into the "coverage gap," whereby their incomes are above current Medicaid eligibility levels for their states, but below the 100 percent FPL minimum to attain federal subsidies for Marketplace insurance coverage. Nearly 90 percent of those in the coverage gap live in the South, and they are disproportionately people of color.
Racial and ethnic minority groups face longstanding and persistent disparities in access to health insurance coverage, resulting in greater barriers to care and poorer health outcomes than their white counterparts. When states choose to expand Medicaid, uninsured adults of color are often the largest beneficiary group. Gaining health coverage through Medicaid increases this population's access to care and promotes greater health equity.
Many people in the coverage gap are parents with dependent children residing in their homes. Studies have demonstrated that providing health coverage to parents reduces children's uninsurance rates as well. Indeed, the largest coverage increases for children have occurred in states that expanded Medicaid to low-income adults.
Many women of reproductive age fall into the coverage gap. Without health coverage, low-income women often forgo important preventive health services such as contraception, screenings for sexually transmitted infections and other services.
Reducing disparities in the use of preconception and inter-conception care is advanced by expanded access to Medicaid. Prior to the ACA, many low-income women had little or no reliable access to health care before or between pregnancies. Studies have shown that lack of preconception and inter-conception care can significantly impact a woman's health and the health of her future pregnancies and children. By basing Medicaid eligibility on income rather than pregnancy status, postpartum women who traditionally lost coverage two months after delivery can retain their coverage under the Medicaid expansion. This offers women an opportunity for on-going care that includes preventive and acute care services, as well as care they may need to manage chronic health conditions.
The mental health of parents affects the health and well-being of children. The prevalence of mental health and substance use disorders is high among uninsured adults. Studies have shown that more than half of all infants living in poverty have a mother with depression. Along with its other benefits, Medicaid expansion can dramatically improve access to treatment for people with mental and substance use disorders, thereby improving health outcomes for themselves and their children.
By lessening the risk of crippling medical debt, the Medicaid expansion can reduce poverty and promote economic security for low-income families. By providing health coverage that is not tied to employment, families have more flexibility to explore training and other educational options to improve their financial circumstances. And with insurance to cover health care costs, families have more money to pay for other goods and services, helping low-income communities to grow economically.
The Medicaid expansion offers states the opportunity to address persistent disparities and improve health equity. By removing financial barriers to health care for low-income adults and families, the Medicaid expansion will have a ripple effect that can positively impact people's lives and the nation's future.