User:Jigmelamo/Medicaid coverage gap

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In the context of American public healthcare policy, the Medicaid coverage gap refers to uninsured people who reside in states which have opted out of Medicaid expansion under the Affordable Care Act (ACA), who are both ineligible for Medicaid under its previous rules that still apply in these states and too poor to qualify for the ACA's subsidies and credits designed to allow middle-class Americans to purchase health insurance. The number of Americans in this gap has been estimated to be almost 3 million as of January 2016, according to the Kaiser Family Foundation. The Foundation has also said that 90% of the people in this gap live in the South.

In states that have not expanded Medicaid, eligibility requirements for Medicaid are limited to parents making 44% or less of the poverty line, and in almost all such states, all adults without children are ineligible. The coverage gap results from this and a number of factors, such as the fact that the ACA was designed so that the poor would receive coverage through Medicaid and so did not include an alternative program for them. For example, as of April 2014, someone living in Texas, a non-expansion state, had to be making less than $3,737 per year to be eligible for Medicaid, and had to make at least $11,490 (if a single person) or $23,550 (for a family of four) to be eligible for ACA subsidies.

The states that chose not to adopt the ACA Medicaid expansion left around 2.2 million people in a Medicaid coverage gap in 2019. These individuals have incomes below the poverty line, which is too low to qualify for subsidized health insurance coverage in the ACA marketplaces. However, they also do not qualify for Medicaid under their state's policies. Individuals in the coverage gap mostly consist of people of color, 1 in 3 were stay-at-home parents with children, 14% of the individuals have disabilities, and half of them in the labor force mostly comprised of caregivers. This tells us that non-expansion state policies hurt the healthcare conditions of socially and economically marginalized individuals. During the Covid-19 pandemic, people of color- Blacks and Latinos in the non-expansion states faced a higher risk of infection, hospitalization, and death. Therefore, introducing ACA Medicaid expansion would help individuals with disabilities, from racial and ethnic minorities, and those who are socially and economically marginalized to receive insurance coverage and improve health outcomes.

Medicaid expansion was made optional for the states in a Supreme Court ruling in 2012.. The majority of the states in the South did not adopt the Medicaid expansion and accounted for 89% of the adults in the Medicaid coverage gap in 2017. Three southern states Kentucky, Arkansas, and Texas had markedly different state policies on Medicaid expansion and therefore produced different application rates, enrollment, and experiences with the 2014 expansion. Kentucky state adopted the traditional Medicaid expansion policy and therefore had the highest enrollment rate which could be due to providing navigators to the public and hosting an application assistance program from the governor’s office. Arkansas did not adopt the traditional Medicaid expansion but adopted the private option and federal-state partnership Marketplace and restricted the states to spend money on promoting them. Texas neither expanded Medicaid nor adopted alternative policies and did not provide any application assistance program to the public. Kentucky had the highest enrollment rate, followed by Arkansas, and Texas with the lowest. Therefore, Texas accounted for 29% of the adults in the Medicaid coverage gap among the non-expansion states in 2017.