Sunday, July 5, 2015

Is the Medicaid expansion occurring in Pennsylvania and New Jersey? How might it affect me?

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As of now, Pennsylvania does not plan to expand its Medicaid program, but New Jersey does. Governor Corbett has hinted that he might change his mind and support the expansion in the future, but so far, he remains opposed.
 
That means all New Jersey residents whose income falls below 133% of the federal poverty level ($15,282 for an individual in 2013) will be eligible for Medicaid beginning next January 1. (The maximum income for eligibility will actually be a bit higher in practice, 138%, because the law uses a revised formula for calculating earnings.) If they earn more than that amount and do not have an employer that offers coverage meeting minimum standards, they can purchase it through an insurance exchange, and if their income is less than 400% of the federal poverty level, they can receive a subsidy to help with the cost.
 
Pennsylvania residents who are currently eligible for Medicaid will continue to receive it as they have in the past. However, residents who are not currently eligible for Medicaid may be caught in a bind. Subsidies for purchasing coverage through an insurance exchange are available at incomes above 100% of the federal poverty level but not below it. (That is because the drafters of the health reform law assumed that all states would choose to expand Medicaid.) That will leave poor Pennsylvanians without access to either Medicaid or subsidies, unless they fall within one of the current Medicaid eligibility categories (pregnant women, families with young children, the elderly, and those who are blind or disabled). The existence of this gap is a major reason that health reform advocates are pushing hard for Pennsylvania to accept the Medicaid expansion.
 
You can find the federal poverty level for 2013 for different household sizes here.

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Robert I. Field, Ph.D., J.D., M.P.H. is a professor of law at the Earle Mack School of Law and professor of health management and policy at the School of Public Health at Drexel University. He also writes for The Field Clinic blog.

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  • Professor, School of Law & Drexel School of Public Health
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