Question: My son is a college graduate (age 27) and no longer is covered under my plan. He works 3 part-time jobs, and makes well under the 400% poverty level. He has a preexisting condition which needs to be checked, but cannot afford it. Can he qualify for Medicaid? Any advice is appreciated.
Answer: Your son’s eligibility for Medicaid depends on his income and state of residence. In states that have expanded their Medicaid programs under the Affordable Care Act, like New Jersey, he would qualify if he earns up to 133% of the federal poverty level ($15,282 in 2013). In states that have not expanded their program, like Pennsylvania, he would qualify only if he falls within one of the categories of people eligible for coverage and meets the income requirement for that category. The categories include pregnant women,children, theseverely disabled, and those who are elderly or blind. There are separate income limits for each one.
However, if your son earns at least100% of the federal poverty level, he would qualify for a subsidy if he purchases coverage on an insurance exchange in any state. His preexisting condition would not affect his eligibility for coverage or the cost. A calculator maintained by the Kaiser Family Foundation (available by clicking here) can help him determine the size of the subsidy he would receive at his income level and the likely cost of coverage.
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. Ask Rob your questions about the new healthcare law.