Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States

Eligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across StatesMay 2014 UpdateMay 2014Under current legislation, just over half (56 percent) of the uninsured became eligible for financial assistance with health insurance coverage through Medicaid, CHIP or subsidized private coverage through the new marketplaces. In states that have expanded Medicaid eligibility under the ACA, 68 percent of the uninsured became eligible for assistance, compared with only 44 percent in states that have not expanded Medicaid. If the latter states were to expand Medicaid eligibility, 71 percent of their uninsured would be eligible for assistance.Among states expanding Medicaid, the ACA is projected to reduce the number of uninsured people by 56 percent, compared with a 34 percent reduction in the uninsured among states not expanding Medicaid. If the states that have not expanded eligibility were to do so, the number of uninsured in those states would decrease by 59 percent. In-BriefUrban InstituteTimely analysis of Immediate Health Policy IssuesMatthew Buettgens, Genevieve M. Kenney, and Hannah RechtHow Many Uninsured People Are Eligiblefor Assistance Under the Affordable Care Act?The Affordable Care Act (ACA) makes health insurance coverage more affordable formillions of low-income families. The map below illustrates the percentage of people in each state who are eligible for coverage assistance programs under the ACA as of May 2014.Percentage of Uninsured Residents Eligible for Insurance Assistance in 2014Nationwide 27.7 MILLION—or 56 percent—of previously uninsured people are eligible for coverage assistance programs under the ACA.States expanding Medicaid States NOT currently expanding Medicaid 50%12,135,00018%4,520,00018% 4,393,00026%6,694,00032% 7,702,00056%14,026,000Eligible for Medicaid/CHIPEligible for SubsidiesNot Eligible for Medicaid/ CHIP or SubsidiesMay 2014Source: Health Insurance Policy Simulation Model-American Community Suvey 2014* Although Wisconsin has not accepted the ACA Medicaid expansion, adults up to 100% of FPL are now eligible for Medicaid and can enroll. Before 2014, there was a limited benefits program for low-income adult nonparents, but enrollment was closed.+ Because Massachusetts has already implemented its own health reform law, the number of uninsured is not expected to change noticeably under the ACA.± New Hampshire plans to expand Medicaid in July 2014.• Pennsylvania and Indiana have submitted Medicaid expansion proposals that are pending CMS review.89-80%79-70%69-59%74-52%51-46%45-40%Expanding StatesNon-Expanding States65%65%73%70%45%55%46%48%67%62%69%58%78%80%48%47%44%46%76%40%42%42%43%50%44%42%47%44%82%83%81%48%• 81%43%49%•66%58%65%+68%65%60%65%62%68%52%±73%47%66%74%*76%76%The data come from an updated Urban Institute report finding that significantly more people are eligible for assistance in states that opted to expand Medicaid coverage versus those states that elected not to expand the program. Timely Analysis of Immediate Health Policy IssuesEligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States2 IntroductionThe Patient Protection and Affordable Care Act (ACA) is already helping millions of low-income families make health coverage more affordable.1 States can choose to expand eligibility for Medicaid to adults and families with incomes up to 138 percent of the federal poverty level (FPL). New health insurance marketplaces offer subsidized private health coverage to people with incomes up to 400 percent of FPL who are not eligible for public coverage, do not have access to employer coverage deemed affordable under the law,2 and are lawfully resident. In states that do not expand Medicaid, those with incomes below 100 percent of the FPL are not eligible for subsidized coverage. In this brief, we examine how many uninsured in each state became eligible for health coverage assistance programs (i.e., Medicaid, the Children’s Health Insurance Program [CHIP], and subsidized private coverage through the new health insurance marketplaces) under the ACA in 2014. In light of the Supreme Court decision that made the Medicaid expansion a state option, our estimates take into account state decisions in effect as of May 2014.3 We then show how the ACA is expected to increase insurance coverage in each state. We estimate the share of the remaining uninsured under the ACA who are projected to be eligible for assistance programs but not enrolled. This group could be reached by additional outreach programs. Finally, we show the percentage of the uninsured eligible for assistance and the change in the number of uninsured for each state both with and without Medicaid expansion. We estimate the share of the uninsured that gained eligibility for assistance in