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
  • Policy and Law
    • Global Healthcare
    • Medical Ethics
  • 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
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

Should We Care If Doctors Drop Medicare?
Not Surprising That Sick People Aren’t Always Happy About Costs
Head of the DOJ’s Antitrust Division Raises Concerns About Two Proposed Mega-Mergers Between Leading Health Insurers
Death Panels Everyone Can Live With
How Financial Barriers are Slowing Down Telehealth Adoption

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

a woman walking on the hallway
6 Easy Healthcare Ways to Sit Less and Move More Every Day
Health
September 9, 2025
Clinical Expertise
Healthcare at a Crossroads: Why Leadership Matters More Than Ever
Global Healthcare
September 9, 2025
travel nurse in north carolina
Balancing Speed and Scope: Choosing the Nursing Degree That Fits Your Goals
Nursing
September 1, 2025
intimacy
How to Keep Intimacy Comfortable as You Age
Relationship and Lifestyle Senior Care
September 1, 2025

You Might also Like

Health Care: A Modern-Day Blade Runner?

December 10, 2014
willing provider
BusinessPolicy & Law

The Willing Provider Problem

July 17, 2013
BusinessHealth Reform

HealthCare’s Need for Transparency Goes Far Beyond Pricing

December 10, 2012
healthcare spending
BusinessFinanceHealth ReformPolicy & LawPublic Health

Why Do Some States Spend More on Health Care?

April 18, 2013
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?