Clinical assistant professor Cossy Hough put together this list of five essential facts that Texas social workers need to know about Medicaid expansion.

1. How did Medicaid expansion come about?

The expansion of Medicaid eligibility was a result of the Affordable Care Act (ACA), which aims at implementing a continuum of health care coverage for all Americans. Due to a 2012 Supreme Court decision regarding ACA, Medicaid expansion is now optional for states.

2. Which states chose not to expand Medicaid and why?

As of summer 2014, 27 states are implementing Medicaid expansion, 19 states are not implementing it, and 5 states are in open debate over the expansion. Texas chose not to expand Medicaid. The Governor’s office cited the cost and expansion of a “broken” Medicaid system as the reason for this decision.

3. What would have been the cost of Medicaid expansion for Texas?

The federal government would have paid 100% of expansion costs for the first three years, and 90% thereafter until 2022. Texas turned away approximately 1 billion dollars in federal funding for Medicaid expansion, and chose not to provide health coverage to approximately 1 million residents. Texas has the option to accept federal funds for Medicaid expansion in the future.

4. What are the implications of not expanding Medicaid?

Without Medicaid expansion, poor uninsured adults fall into a health care coverage gap. They may live below the Federal Poverty Line (FPL), but earn too much to qualify for Medicaid and not enough to qualify for the subsidies that those at higher incomes can use to help purchase health care coverage under ACA.

5. What is the impact for clients in Texas?

Children and pregnant women in low-income families may still qualify for Medicaid. Adults with disabilities or needing long term care still may qualify as well. Parents may only qualify if they make 19% or less of the FPL (as of January 2014). Adults outside of these categories will likely not qualify for Medicaid. Adult clients who make less than 100% of the FPL will not qualify either for subsidies available to those who make between 100-400% to assist in the purchase of health insurance coverage. Some examples:

  • A working adult without a child and without a disability who makes $9,000 per year will not qualify for Medicaid, and will not qualify either for a subsidy to assist in purchasing health coverage.
  • A single mother of two children who makes $18,000 per year will not qualify for Medicaid or a subsidy either. Her children will likely qualify for Medicaid.
  • A single mother with two children who makes $21,000 per year will qualify for a subsidy under ACA, as she is between 100-400% of the FPL.

For additional information, visit The Center for Public Policy Priorities.