Medicaid Expansion for the Middle Class?

Current Medicaid programs’ eligibility varies by state. In 2014, a provision within the Patient Protection and Affordable Care Act (PPACA) will expand Medicaid eligibility to people making up to 133 percent of the federal poverty level (FPL). The provision also includes a new method for calculating Medicaid eligibility which is determined by a person’s modified adjusted gross income (MAGI).

Concerns have been raised over the new eligibility calculations as they exclude certain benefits, such as Social Security. CMS Medicare chief actuary, Richard Foster, states that it would be possible for a married couple each receiving $25,000 annually in Social Security benefits to still qualify for Medicaid if their other income is at or below 133 percent of the FPL.

The GOP has pounced on this issue stating there is a desperate need to reform the Medicaid provisions in PPACA to ensure only the poorest people are eligible for Medicaid enrollment. They claim the MAGI eligibility criteria will permit middle income people to game the system and enroll into Medicaid programs, dramatically increasing federal and state healthcare costs.

A senior official at the Health and Human Services (HHS) has stated they are aware MAGI eligibility calculations could potentially allow middle income people to qualify for Medicaid and they are currently working on a solution to ensure only the “neediest Americans” are served by Medicaid programs.