Ten Miles Square

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September 06, 2012 10:43 AM Medicaid! - Introduction

By Aaron Carroll

President Clinton gave me the opening last night, and I’m going to take it. I’m just thrilled that someone brought up Medicaid.

While the discussion this year has focused on Medicare, the differences in Medicaid between the two opposing campaigns are far starker. No matter which party wins, Medicare will look much as it does today for quite some time. Medicaid, however, could change drastically. And still – no one has been talking about it:

Other than a small spike in Medicaid related coverage around the Supreme Court ruling, Medicare (that big mountain on the right) has totally crushed it. As @ddiamond says, “Are we *writing* too much about Medicare – and not enough about Medicaid?”

It’s important to remember that Medicaid is not the universal safety net program many think it is. Let’s start there (updated):

Medicaid must cover:


  • Kids under 6 years of age to 133% FPL
  • Kids 6-18 to 100% FPL
    • SCHIP upps this in most states
  • Pregnant women up to 133% FPL
  • Parents to 1996 welfare levels
  • The elderly and those with disabilities who receive SSI

Now, states get to implement things above that as they see fit. But the first important thing to note is that adults without children aren’t mentioned at all. And in most states, they can’t get Medicaid.

Let me say that again - in most states even the poorest adults without children don’t get Medicaid.

And it gets worse. Those 1996 welfare levels can be super low. So low that, for instance, in Arkansas a working couple with two children making $4600 a year doesn’t qualify for Medicaid. Granted, some states are more generous. But in many, parents have to be very, very poor in order to get Medicaid.

If you’re an adult without a child under the age of 18, in almost all states – it does not matter how poor you are, you can’t get Medicaid. Period.

The ACA changes all this. It creates a universal safety net program for health care by giving everyone in America who makes less than 133% FPL Medicaid. Period.

About 16 million uninsured Americans fall under that level. That’s more than half the people who will get insurance under the ACA. One candidate wants to repeal that law and the other does not. That’s a huge, huge deal.

[Cross-posted at The Incidental Economist]

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Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine.
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