Issues in health reform: How changes in eligibility may move millions back and forth between medicaid and insurance exchanges

Health Affairs

Volumn 30, Issue 2, 2011, Pages 228-236

  Sommers, Benjamin D ^a   Rosenbaum, Sara ^b  

^a HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

^b GEORGE WASHINGTON UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH INSURANCE; INCOME; MEDICAID;

ADULT; CONTINUITY OF PATIENT CARE; ELIGIBILITY DETERMINATION; FAMILY CHARACTERISTICS; FEMALE; FINANCING, GOVERNMENT; HEALTH CARE REFORM; HEALTH POLICY; HEALTH SERVICES ACCESSIBILITY; HEALTH SURVEYS; HUMANS; INCOME; INSURANCE COVERAGE; MALE; MEDICAID; POVERTY; PROGRAM EVALUATION; QUALITY ASSURANCE, HEALTH CARE; STATE HEALTH PLANS; UNITED STATES;

EID: 79955548592     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2010.1000     Document Type: Article

References (20)

1. Affordable Care Act, Pub. L. 111-148 and 111-152; 2010. Sec. 2001, Medicaid coverage for lowest income populations. Revises United States Code, Title 42, Sec. 1396a(a)(10), State plans for medical assistance. Further revised by the Health Care and Education Reconciliation Act of 2010, Pub. L. 100-152.
2. Internal Revenue Code, Sec. 36B(b) (3)(A), added by Sec. 1401 of the Affordable Care Act. Legal US residents with family incomes below 100 percent of the federal poverty level who have not resided in the United States long enough to qualify for Medicaid instead will receive premium credits through their state exchanges.
3. Medicaid eligibility, like eligibility for cash welfare, historically has been tied to monthly income. At their option, states can limit eligibility redeterminations to once annually, but federal regulations require that individuals report interim changes in income, and when such information is received, states must promptly redetermine eligibility. 42 CFR, Sec. 435.916, Periodic redeter-minations of Medicaid eligibility.
4. Short PF, Graefe DR. Battery-powered health insurance? Stability in coverage of the uninsured. Health Aff (Millwood). 2003;22(6):244-55.
5. Fairbrother GL, Emerson HP, Partridge L. How stable is Medicaid coverage for children? Health Aff (Millwood). 2007;26(2):520-28.
6. Sommers BD. Loss of health insurance among non-elderly adults in Medicaid. J Gen Intern Med. 2009;24(1):1-7.
7. The Medicare and Medicaid Extenders Act, Pub. L. No. 111-309; 2010. Sec. 208 finances the latest version of Congress's fix to the Medicare physician payment problem by increasing the size of the advance payment recoupment to which individuals are exposed. Specifically, this legislation amends Sec. 36B of the Internal Revenue Code, as added by the Affordable Care Act, to significantly increase repayment obligations by individuals who receive advance tax credits based on prior-year income and whose incomes then rise during the enrollment year. Under the Affordable Care Act, the maximum repayment penalty was $400; the more recent legislation increased this penalty to $500 for individuals and families with incomes below 200 percent of the federal poverty level and to as much as $2,500 in the case of individuals with family incomes of 350-400 percent of the poverty level.
8. Long SK, Coughlin T, King J. How well does Medicaid work in improving access to care? Health Serv Res. 2005;40(1):39-58.
9. Weissman JS, Stern R, Fielding SL, Epstein AM. Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med. 1991; 114:325-31.
10. Ku L, Ross DC. Staying covered: the importance of retaining health insurance for low-income families. Washington (DC): Center on Budget and Policy Priorities; 2002.
11. Lavarreda SA, Gatchell M, Ponce N, Brown ER, Chia YJ. Switching health insurance and its effects on access to physician services. Med Care. 2008;46(10):1055-63.
12. Waves 2-4 of the 2004 survey contained an income imputation error for some households. This result does not appear to have biased our results since the 2008 data (unaffected by this error) produce the same findings. US Census Bureau. SIPP 2004 panel general income user note [Internet]. Washington (DC): The Bureau; 2008 Feb 19 [cited 2010 Dec 12]. Available from: http://www.census.gov/sipp/core_content/core_notes/2004General_Income.html.
13. To access the Appendix, click on the Appendix link in the box to the right of the article online.
14. US Department of the Treasury. Income mobility in the US from 1996 to 2005. Washington (DC): The Department; 2007 (revised 2008).
15. Congressional Budget Office. Trends in earnings variability over the past 20 years. Washington (DC): CBO; 2007.
16. Internal Revenue Code, Sec. 5000A (e)(2), exempts from the mandate any individual with income below the code's filing threshold for a taxable year. In 2009, the threshold was $9,350 for an individual and $18,700 for a couple. Internal Revenue Service. 1040EZ instructions 2010 [Internet]. Washington (DC): IRS; 2010 [cited 2010 Dec 12]. Available from: http://www.irs.gov/pub/irs-pdf/i1040ez.pdf.
17. Affordable Care Act, Sec. 1311, Affordable choices of health benefit plans, and Sec. 1401, Refundable tax credit providing premium assistance for coverage under a qualified health plan.
18. 42 US Code, Sec. 1396a(a)(34). "A State plan for medical assistance must...provide that in the case of any individual who has been determined to be eligible for medical assistance under the plan, such assistance will be made available to him for care and services included under the plan and furnished in or after the third month before the month in which he made application (or application was made on his behalf in the case of a deceased individual) for such assistance if such individual was (or upon application would have been) eligible for such assistance at the time such care and services were furnished.".
19. 42 US Code, Sec. 1396u-7(b), defines "benchmark coverage" for the Medicaid eligible expansion group under the Affordable Care Act; coverage was amended in Sec. 2001(c) of the act.
20. Rosenbaum S, Wise PH. Crossing the Medicaid-private insurance divide: the case of EPSDT. Health Aff (Millwood). 2007;26(2):382-93.