Medicaid expansion & what it means for you
Some states are expanding their Medicaid programs. Others haven’t. Your health coverage options depend on your state, your income and household size, and other factors.
Whether you qualify for Medicaid coverage depends partly on whether your state has expanded its program.
- In all states: You can qualify for Medicaid based on income, household size, disability, family status, and other factors. Eligibility rules differ between states.
- In states that have expanded Medicaid coverage: You can qualify based on your income alone. If your household income is below 133% of the federal poverty level, you qualify. (Because of the way this is calculated, it turns out to be 138% of the federal poverty level. A few states use a different income limit.)
Find out if your state is expanding Medicaid.
The following states are expanding their Medicaid programs.
- District of Columbia
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Dakota
- Rhode Island
- West Virginia
The following states have not decided to expand their Medicaid programs.
- North Carolina
- South Carolina
- South Dakota
If your income is low and your state hasn’t expanded Medicaid
If your state hasn’t expanded Medicaid, your income is below the federal poverty level, and you don't qualify for Medicaid under your state's current rules, you won’t qualify for either health insurance savings program: Medicaid coverage or savings on a private health plan bought through the Marketplace.
- When the health care law was passed, it required states to provide Medicaid coverage for all adults 18 to 65 with incomes up to 133% (effectively 138%) of the federal poverty level, regardless of their age, family status, or health.
- The law also provides premium tax credits for people with incomes between 100% and 400% of the federal poverty level to buy private insurance plans in the Health Insurance Marketplace.
- The U.S. Supreme Court later ruled that the Medicaid expansion is voluntary with states. As a result, some states haven’t expanded their Medicaid programs.
- Adults in those states with incomes below 100% of the federal poverty level, and who don’t qualify for Medicaid based on disability, age, or other factors, fall into a gap.
- Their incomes are too high to qualify for Medicaid in their states.
- Their incomes are below the range the law set for savings on a Marketplace insurance plan.
States are continuing to make coverage decisions. They could expand Medicaid in the future.
Apply for Medicaid coverage, even if your state hasn’t expanded
Even if your state hasn't expanded Medicaid, you should apply for coverage to see if you qualify. Each state has coverage options that could work for you – particularly if you have children, are pregnant, or have a disability.
Each state has coverage options that could work for you – particularly if you have children, are pregnant, or have a disability. And when you provide more detailed income information you may fall into the range to save.
If you don’t qualify for either Medicaid or Marketplace savings
- You can get care at a nearby community health center. The health care law has expanded funding to community health centers, which provide primary care for millions of Americans. These centers provide services on a sliding scale based on your income. See how to get low-cost care in your community.
- If you don’t have any coverage, you don’t have to pay the fee. Under the law, most people must have health coverage or pay a fee. But you won’t have to pay this fee if you live in a state that hasn’t expanded Medicaid and you would have qualified if it had. This is called having an exemption from the fee. You can get an exemption when you apply for coverage in the Marketplace. Or you can apply for the exemption without having to fill out a Marketplace application.
- If your expected yearly income increases so it’s between 100% and 400% of the federal poverty level, you become eligible for a Marketplace plan with advance payments of the premium tax credit. In this case, you may qualify for a Special Enrollment Period (SEP) that allows you to enroll in a Marketplace plan any time of year. You must contact the Marketplace Call Center within 60 days from the date your income changed to request this SEP. When you call, you’ll need to attest that you:
- Weren’t eligible for Medicaid when you first applied because you live in a state that hasn’t expanded Medicaid
- Weren’t eligible for a Marketplace plan with tax credits when you first applied because your income was too low
- Had an increase in expected yearly income that now qualifies you for a Marketplace plan with tax credits