Congressional Quarterly is outlining some of the new details in the currently hidden health reform bill. There is one idea that sounds like it is an improvement over the first round of leaking but is still a disaester. It concerns grandfathering federal match rates for current Medicaid Expansion beneficiaries.
Sen. Rob Portman, R-Ohio, whose state expanded Medicaid, explained the new idea.
“They’re talking about ways to keep people who are in expanded Medicaid from having the rug pulled out from under them — specifically, not changing the expanded Medicaid over the transition period or even beyond, as long as you’re on Medicaid expansion. If you leave Medicaid expansion and later want to get back on, then you go under normal [matching rates],” he said. “It’s a lot better than what they were talking about initially, from my point of view.”
While many House lawmakers told CQ Roll Call they had concerns about increasing the size of the Medicaid population, they hope that individuals would eventually transition out of the program once they gain employment or purchase coverage on the individual marketplace.
I want to talk about Mary. She is a young woman of prime childbearing age. She works. Her husband is in school and is very healthy. They make 112% of the Federal Poverty Line from her job at Sheetz. They both qualify for Medicaid Expansion in Pennsylvania. She gets pregnant. Her husband picks up some hours at Sheetz as well as they want to put aside some money for the birth. They now make 150% FPL. Her husband is dropped from Medicaid Expansion. She is also dropped from Medicaid Expansion but qualifies for Legacy Medicaid. He buys a Bronze plan for $11 a month out of pocket.
Nine months later, Mary has a happy, healthy baby girl who has an inscrutable smile. The increased family size plus the reduction in hours worked by Mary has dropped family income to 131% FPL. The baby is covered either through Legacy Medicaid or no cost CHIP. Mary and her husband are now Medicaid Expansion eligible again. He loses access to his Exchange subsidy as he has Medicaid coverage eligiblity. They both sign up for Medicaid Expansion again and are told that they only qualify for either a waiting list or greatly reduced benefit package because the match rate has gone from 90% to 55% and the state can’t afford to fund their insurance.
Churn is a fact of life for low income eligibility programs. People have a good stretch at work so they go above guidelines and are either dropped or moved to a different program. People have a bad stretch of work as hours are cut due to seasonality, bad luck or personal situations. Kids are born. People are married. People are divorced. Life happens. Right now, most of these changes would result in a new ID card for health insurance. Under the temporary grandfathering of the federal match rate, the vast majority of the Medicaid Expansion population will become at least temporarily ineligible due to a good stretch and their funding then disappears.
Churn and maternity in Medicaid ExpansionPost + Comments (37)