Who now has Medicaid insurance in Pa. and N.J. - before possible expansion

Expansion of Medicaid in January is at the core of the federal health-care overhaul's effort to reduce the number of Americans without health insurance. In June, the U.S. Supreme Court decision on the constitutionality of the Affordable Care Act, however, made Medicaid expansion optional for states, rather than mandatory.

Though neither Gov. Christie in New Jersey nor Gov. Corbett in Pennsylvania has shown an interest in expanding Medicaid, it's difficult to understand what that means for the states, in part because future governors may opt to expand it and because grasping who is currently covered by Medicaid is not easy.

"There are more than 43 categories of eligibility" in Pennsylvania, said Beth Balaban, senior budget analyst for the Democrats on the state House Appropriations Committee.

Following is a look at who now has health insurance through Medicaid, focusing on adults who are younger than 65 and not disabled. Low-income children, the elderly, and the disabled are covered under a patchwork of Medicaid programs.

Most eligibility criteria are based on individual or household income relative to the federal poverty level. An individual with less than $11,170 in annual income and a family of four with annual income of less than $23,050 were considered to be in poverty last year by federal standards.

Pennsylvania. All parents who receive aid under the federal cash-assistance program called Temporary Assistance for Needy Families (TANF) are covered by Medicaid.

To qualify, a family must have annual income of less than 50 percent of the poverty level, Balaban said. For a parent and three children, that would have been less than $11,525 in 2012.

In December, 414,042 adults and their children were eligible for coverage through this category.

The biggest group to qualify for Medicaid, 601,945 in December, is made up of families who do not qualify for TANF cash aid but have high medical expenses that can be deducted from their income, making them eligible for Medicaid.

Finally, 217,753 qualified for cash assistance and Medicaid but opted to accept only Medicaid, perhaps because there is a lifetime limit of 60 months on TANF cash assistance.

For childless adults who are not disabled, there is no option, even for the very poor, under current Medicaid rules.

New Jersey. This state is a bit more generous: Parents with incomes up to 133 percent of the poverty level - or up to $30,657 for a family of four - are eligible for Medicaid.

Before a March 2010 program freeze, families with incomes up to twice the federal poverty level qualified. In December, 242,253 parents and 701,910 children were enrolled.

New Jersey has an option for single, childless, able-bodied adults. If they earn no more than the state's cash benefit for the poor - $140 per month, or $1,680 annually - they qualify for Medicaid. The category counted 43,852 adults last month.

Medicaid expansion. If New Jersey opts to expand, that would open up coverage to single, childless adults who earn more than $1,680 and less than $15,415 annually. The Urban Institute Health Policy Center estimated that would make 307,000 additional adults eligible.

In Pennsylvania, where there is no health-insurance safety net for able-bodied, childless adults, the Urban Institute estimated that 520,000 would be newly eligible under a Medicaid expansion.

at 215-854-4651 or hbrubaker@phillynews.com.