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Wednesday, September 25, 2013

Expert Q&A: Medicaid Eligibility in the Marketplaces

Sanjay Kishore

Villers Fellow

This is the third blog in our Expert Q&A series on the Affordable Care Act. Our experts will answer common questions that people may have about open enrollment, which starts on October 1.  

Starting on October 1, millions of Americans will be able to sign up for health coverage through health insurance marketplaces. In addition to private insurance, consumers can use the marketplaces to apply for Medicaid, which is a public insurance program that offers health care at little or no cost to people with low incomes. Here, we address three common questions about Medicaid under the Affordable Care Act:

Q: Can I get Medicaid?

A: The short answer: it depends on your state. In the past, Medicaid provided coverage to specific groups of low-income people: pregnant women, children (and in some cases, their parents), the elderly needing long-term care, and so on. The Affordable Care Act expanded this coverage to all citizens or qualified immigrants with annual incomes below 138 percent of the federal poverty level (nearly $16,000 for an individual). This expansion is especially important for childless adults who are working part-time or who are unemployed. However, the Supreme Court ruled that the expansion was optional for states. As of now, 25 to 30 states plan to expand Medicaid by early next year.

Q: It sounds like I might be eligible. How do I sign up?

A: Check to see if your state is expanding Medicaid here. If it is, you can enroll in Medicaid through the health insurance marketplace. Just visit, select your state, and sign up! Each state has also assembled a group of people who can walk you through the application process either in person or over the phone. You can use to find out more about the marketplace and who can help you apply.

If your state has not expanded Medicaid, you should still apply for insurance through the marketplace because there are many options for affordable health coverage. For instance, even if your income is too high for Medicaid, you may qualify for financial assistance to help pay the premiums for your choice of private insurance plans. In some cases, this financial assistance can pay for up to 90 percent of your premiums! Individuals with incomes up to about $46,000 a year (and up to about $94,000 for a family of four) could be eligible for this new financial assistance. And if you don’t qualify for this help, you can still receive essential care at your local community health center.

Q: How can I help my state expand Medicaid?

States can decide to expand Medicaid at any time, and if your state moves quickly, the federal government will pay the full cost of the expansion for three years, and more than 90 percent of the costs thereafter. If you are passionate about access to health care, contact your state representatives and your governor to let them know you support Medicaid expansion.  Please visit our Medicaid Expansion Center to learn more.

Medicaid expansion under the Affordable Care Act will provide vital health coverage to many Americans at little or no cost—and you could be eligible! Find out if you qualify for Medicaid or other options for affordable health insurance by visiting