Health Q&A: How is Medicaid changing?

December 21, 2013

A look at questions related to recent health-care news. Today’s focus: people covered by Medicaid, the health insurance program operated jointly by state and federal governments.

How is Medicaid affected by the health-care law?

Across the country, Medicaid serves about 58 million poor or disabled people. (It should not be confused with Medicare, the health program for Americans 65 and over, though many of Medi­caid’s beneficiaries are low-
income elderly people.)

The Affordable Care Act made some pretty substantial changes to Medicaid. First, it allowed states, starting Jan. 1, to expand the program to include anyone who makes up to 138 percent of the federal poverty level — about $15,800 for an individual and $32,500 for a family of four.


This is a big change, because most states only opened Medicaid to children, pregnant women, some very low-income parents, people with disabilities and the elderly. They excluded childless adults.

About half of states decided not to expand their Medicaid programs under the law. To find out if you qualify for Medicaid, go to HealthCare.gov, the federal health insurance marketplace, or call the government’s hotline at 1-800-318-2596.

I’m on Medicaid now. How does the Affordable Care Act affect me?

You won’t be affected dramatically. The law changes the way the program does a few things, and if you have a lot of new Medi­caid beneficiaries in your community you may find that providers who accept Medicaid are inundated with new patients, making it harder to get an appointment.

I signed up for Medicaid on the health insurance exchange in my state, but I have not gotten an insurance card or any confirmation that I am enrolled Jan. 1. What should I do?

You are not alone. States are not getting good information from the federal government about who is signing up for Medi­caid through the federal marketplace, which may be the problem. Technology experts with the states and the federal government are working on this technical issue.

Meantime, you should not be shy about checking in with your state Medicaid office as well as the federal marketplace, if that is how you tried to sign up. If you don’t receive a satisfactory answer right away, don’t panic — one benefit of Medicaid is that, unlike private health insurance, it will cover you retroactively.

I got on the health insurance marketplace and learned that I qualify for Medicaid. But I’d rather get a subsidy and buy a private plan with my local insurance company. Can I do that instead?

No, unless you live in Arkansas or Iowa. Both states negotiated a deal with the federal government to use their Medicaid expansion dollars to buy private health plans for people who qualify under the expansion.

Alternatively, you could go outside the exchange and buy a plan directly from the health insurance company. But you won’t be able to get a subsidy to help you pay your premiums.

I just joined Medicaid. Will my health care be as good as the care received by people who have private insurance?

There is a big debate about this, and like so much else, it is wrapped up in politics and ideology. Critics of the program, many of whom happen to be Republican and support a more limited role for government, say no. Proponents of the program, many of whom happen to be Democratic and support a larger role for government in people’s lives, say yes.

The critics point out that doctors and hospitals are re­imbursed at a lower rate for patients with Medicaid than those with private plans. They say that reduces the quality of patient care and limits patients’ options of providers. And they cite studies that show Medicaid recipients have poorer health than those with private coverage.

Supporters say Medicaid offers high-quality care and note that people shifting from private plans often will be able to keep going to their previous doctors — but at a vastly lower cost. They say the studies showing poorer health outcomes for people on Medicaid can be explained by the fact that the program covers some of the nation’s sickest people. And they cite their own studies showing people’s health improves when they move from the ranks of the uninsured to Medicaid.

Sandhya Somashekhar is a health reporter for the Washington Post.
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