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Kaiser Family Foundation Issues Report on Upcoming Changes to Medicaid Programs

November 14, 2013

The Kaiser Family Foundation issued a report on Oct. 7, 2013, detailing planned and projected changes to state Medicaid spending and enrollment in 2014.

  • Arkansas plans to eliminate income and resource limits for its Workers with Disabilities program, which permits individuals with disabilities to “buy in” to Medicaid coverage while employed.
     
  • Another three states – Florida, Louisiana, and New Jersey – plan to increase income and/or asset limits for individuals in the medically needy and long-term care eligibility categories. These categories include individuals with high medical expenses and individuals who require long-term support with daily living.
     
  • In contrast, Kentucky plans to eliminate Medicaid coverage for workers with disabilities with incomes above 138 percent of the federal poverty line (FPL); however, this population will be eligible for premium subsidies in the new statewide health insurance marketplace.

Under the ACA, states have the option of extending Medicaid coverage to all adults under 65 who earn less than 133 percent of the FPL. This population may include many workers with disabilities who were not previously enrolled in Medicaid because they did not qualify for coverage under other programs, such as those whose income and assets were too high to qualify for Medicaid through the Supplemental Security Income (SSI) program. States may choose to provide individuals in the Medicaid expansion population with coverage either through the traditional Medicaid program or through an alternative, often more limited, “Benchmark” plan. Nevertheless, individuals with significant mental or physical disabilities will be classified as “medically frail” and thus entitled to coverage through the traditional Medicaid program.

The Kaiser Family Foundation reports that roughly half of all states opting into the Medicaid expansion will offer long-term supports and services (LTSS) to some members of the expansion population. Workers and jobseekers with disabilities in these states will benefit from the option of receiving LTSS while earning incomes up to 133 percent of the FPL. Notable examples include: 

  • New York, which reported to the Kaiser Family Foundation that the Benchmark plan it offers the expansion population will cover community-based LTSS but not nursing home care. This focus on community-based services will be a particular advantage to workers with disabilities in the expansion population.
     
  • California, which plans to seek waiver authority to limit coverage for LTSS for members of the Medicaid expansion population to those who have assets below a certain limit. The inability to build up savings while receiving LTSS may disadvantage low-income workers with disabilities.

The Kaiser Family Foundation also predicts that changes to eligibility criteria, in concert with streamlined enrollment procedures, will cause Medicaid enrollment to rise significantly in 2014, even in states that have opted out of the Medicaid eligibility expansion under the Affordable Care Act. Kaiser Family Foundation predicted a 5.3 percent increase in Medicaid enrollment among such “optout” states and an 11.8 percent increase in enrollment among states that accept the Medicaid eligibility expansion. State spending growth on Medicaid will be higher among states that opt out of the Medicaid expansion than among states that opt in, due in part to the ACA’s provision of full federal financing for the expansion population in “opt in” states until 2016.

The report is available at http://kff.org/medicaid/report/medicaid-in-a-historic-time-oftransformation-results-from-a-50-state-medicaid-budget-survey-for-state-fiscal-years-2013-and-2014/