By using this site, you agree to the Privacy Policy and Terms of Use.
Accept
Health Works CollectiveHealth Works CollectiveHealth Works Collective
  • Health
    • Mental Health
    Health
    Healthcare organizations are operating on slimmer profit margins than ever. One report in August showed that they are even lower than the beginning of the…
    Show More
    Top News
    benefits of using protein powder to build muscles
    Protein Powder for Muscle Mass: Everything You Need to Know
    December 12, 2021
    changes brought on by blockchain in healthcare
    Technology In The Healthcare Industry
    March 28, 2022
    What Does Core Body Temperature Say About Health?
    August 17, 2022
    Latest News
    Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
    May 16, 2025
    Learn how to Renew your Medical Card in West Virginia
    May 16, 2025
    Choosing the Right Supplement Manufacturer for Your Brand
    May 1, 2025
    Engineering Temporary Hospitals for Extreme Weather
    April 24, 2025
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
    Policy and Law
    Get the latest updates about Insurance policies and Laws in the Healthcare industry for different geographical locations.
    Show More
    Top News
    FDA Approves Diabetes Pill
    May 2, 2011
    Patient Gets Drunk on Hand Sanitizer
    June 20, 2011
    Cultivating Health Improvement
    July 20, 2011
    Latest News
    Building Smarter Care Teams: Aligning Roles, Structure, and Clinical Expertise
    May 18, 2025
    The Critical Role of Healthcare in Personal Injury Recovery: A Comprehensive Guide for Victims
    May 14, 2025
    The Backbone of Successful Trials: Clinical Data Management
    April 28, 2025
    Advancing Your Healthcare Career through Education and Specialization
    April 16, 2025
  • Medical Innovations
  • News
  • Wellness
  • Tech
Search
© 2023 HealthWorks Collective. All Rights Reserved.
Reading: Not Poor Enough for Medicaid? Meet the ‘New’ Medicaid Doughnut-Hole
Share
Notification Show More
Font ResizerAa
Health Works CollectiveHealth Works Collective
Font ResizerAa
Search
Follow US
  • About
  • Contact
  • Privacy
© 2023 HealthWorks Collective. All Rights Reserved.
Health Works Collective > Policy & Law > Health Reform > Not Poor Enough for Medicaid? Meet the ‘New’ Medicaid Doughnut-Hole
Health Reform

Not Poor Enough for Medicaid? Meet the ‘New’ Medicaid Doughnut-Hole

Chris Hoffmann
Last updated: July 13, 2012 7:48 am
Chris Hoffmann
Share
3 Min Read
SHARE

The U.S. House had yet another symbolic vote yesterday to repeal the health reform legislation.  While previous efforts to undo the law have been unsuccessful and the Senate will no doubt ignore the House action, GOP leaders are digging in on their opposition in advance of the fall elections.

The U.S. House had yet another symbolic vote yesterday to repeal the health reform legislation.  While previous efforts to undo the law have been unsuccessful and the Senate will no doubt ignore the House action, GOP leaders are digging in on their opposition in advance of the fall elections.

Amid the rancor, we have been evaluating the political and economic impacts of the June 28 SCOTUS ruling that gives states the option of whether or not to comply with ACA’s Medicaid expansion provisions that extends eligibility to individuals with income at or below 133% of the federal poverty level (FPL). With this flexibility, many states are contemplating setting eligibility at 100% FPL or below.

While the SCOTUS ruling maintains States’ rights granted by the Constitution, the potential outcome for up to 24 million individuals Americans is a “doughnut hole” – not poor enough for Medicaid and too poor for ACA’s federal tax subsidies (to offset the cost of insurance since subsidies will only be available to those with household income between 133% and 400% of the federal poverty level).

More Read

Medicaid to Fund ‘Stay-Healthy’ Incentive Programs
The Impact of US Healthcare Spending [INFOGRAPHIC]
Doctors Opting Out
Digital Health’s Future Calls for New Regulatory Vision
Iowa’s in the National News Right Now, and It’s for a Reason You Wouldn’t Expect

Below 133% of FPL no subsidy is available via the exchanges because the legislation assumed that those individuals would be Medicaid eligible. Said differently, the SCOTUS ruling could leave millions of low income individuals without insurance.

  • Some of these individuals will likely get a hardship waiver so as not to be charged the tax for “no-insurance”, but they could still remain uninsured.
  • Other consumers who are just below the FPL requirement of subsidy eligibility may find themselves without insurance, and resort to “gaming the system” by over reporting income to get within the subsidy eligibility band.  It’s important to note that subsidies are only available for people purchasing coverage through the state Exchange (not through an employer).

While calculations are still early, states like Nevada estimate (that if they expanded to federal guidelines) they would have to pay an additional $567 million in Medicaid costs between 2014 and 2019 to provide health insurance to people who earn up to 133 percent of the federal poverty level.  This kind of thinking among states will influence whether they will refuse the fed’s funding offer of 93% of expansion costs through 2022…a lot of calculus, a lot of confusion.

Look for us to continue assessing and reporting on the impact of the Medicaid decision on Managed Medicaid, the dual eligible population and insurance exchanges. Until then, let us know what you think.

TAGGED:Medicaid
Share This Article
Facebook Copy Link Print
Share

Stay Connected

1.5kFollowersLike
4.5kFollowersFollow
2.8kFollowersPin
136kSubscribersSubscribe

Latest News

Do You Grind Your Teeth at Night? Here’s How Night Guards and TMJ Treatments Can Help
Do You Grind Your Teeth at Night? Here’s How Night Guards and TMJ Treatments Can Help
Dental health
May 21, 2025
The Secret To A Confident Smile: Top Tips For Better Teeth
The Secret To A Confident Smile: Top Tips For Better Teeth
Dental health
May 21, 2025
Clinical Expertise
Building Smarter Care Teams: Aligning Roles, Structure, and Clinical Expertise
Health care
May 18, 2025
Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
Grounded Healing: A Natural Ally for Sustainable Healthcare Systems
Health
May 15, 2025

You Might also Like

American Healthcare is Facing-Off Against Google—And Losing

February 18, 2016

Five Factors Improving the State of Mental Health Care

November 17, 2015

Making The Case for Behavioral Health Integration

March 18, 2016

Disruptions on the Yellow Brick Road

April 28, 2015
Subscribe
Subscribe to our newsletter to get our newest articles instantly!
Follow US
© 2008-2025 HealthWorks Collective. All Rights Reserved.
  • About
  • Contact
  • Privacy
Welcome Back!

Sign in to your account

Username or Email Address
Password

Lost your password?