Skip to main content

Millions Below 133 Percent of Federal Poverty Line Will Be Ineligible for Health Insurance Through the Exchanges in States Opting Out of Medicaid Expansion

November 14, 2013

Despite the opening of the health insurance marketplaces on Oct. 1, 2013, individuals with incomes below 133 percent of the FPL will not be eligible for subsidized insurance premiums through the statewide insurance marketplaces. Although this population was to benefit from the Affordable Care Act’s expansion of Medicaid eligibility to adults below 133 percent of the FPL, more than 20 states have opted out of the expansion. The Congressional Budget Office estimates that approximately three million additional people will remain uninsured as a result of their states’ decision not to expand Medicaid eligibility criteria. Lack of access to health care either through Medicaid or statewide exchanges will disproportionately affect workers with disabilities who have incomes below 133 percent of the federal poverty line and are not otherwise eligible for Medicaid, but require regular medical intervention and/or LTSS. This problem may be compounded by employers who previously provided health care to part-time employees but will now instead provide premium reimbursements for health insurance purchased through statewide exchanges. Workers with disabilities with incomes below 133 percent of the FPL may be forced to apply for Supplemental Security Income (SSI) in order to obtain Medicaid coverage, which may require exiting the workforce.

The Congressional Budget Office Report is available at