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States’ Refusal to Expand Medicaid Will Leave Direct-Care Workers Uninsured

October 17, 2013

Recent analyses of the impact of the Affordable Care Act (ACA) estimate that as many as eight million low-income Americans will continue to lack coverage after the law’s coverage provisions take effect on January 1, 2014.

A New York Times analysis of census data found that “two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance” will continue to lack coverage because 26 states have refused to expand eligibility for Medicaid to all adults earning up to 138 percent of the federal poverty level (FPL), as called for in the ACA.

Unfortunately, many direct-care workers will be among those who are left out. Nationwide, more than one million direct-care workers live in households earning less than 138 percent of the FPL, and nearly half (465,000) currently lack coverage. Without implementation of the ACA’s Medicaid expansion in all states, many of these workers will remain uninsured.

A new analysis (pdf) from the Kaiser Family Foundation notes that in 23 of the 26 states that have rejected Medicaid expansion, more than 80 percent of poor uninsured non-elderly adults will fall into a “coverage gap” between eligibility for Medicaid (which varies in states that are choosing not to expand) and eligibility for ACA premium subsidies. Furthermore, the analysis finds that “over half of those in this ‘coverage gap’ live in five states: Texas, Florida, Georgia, North Carolina, and Ohio.”

Under the ACA, the federal government will pay 100 percent of the cost for newly eligible Medicaid recipients in states that expand Medicaid eligibility through 2016. The federal cost sharing will decrease to no less than 90 percent by 2020.

Individuals with family income between 100 and 400 percent of FPL are eligible for federal subsidies to buy private insurance on the state or federal insurance exchanges. However, individuals whose income falls below that level are not eligible for the federal subsidy. More than 80 percent of direct-care workers live in households with income less than 400 percent of FPL.

“The women and men of America’s direct-care workforce work every day to provide life-sustaining care to older adults and people with disabilities,” said Carol Regan, PHI government affairs director. “It’s unconscionable that many of them will continue to lack access to affordable coverage due to the failure of some states to expand Medicaid.”

— by Gail MacInnes, PHI National Policy Analyst

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