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Utah, Nebraska, and Idaho will join 33 states and the District of Columbia in expanding Medicaid under the Affordable Care Act.
The expansion will take place under a provision of the ACA that extends health care coverage through Medicaid to individuals with incomes up to 138% of the Federal Poverty Level. Because of a Supreme Court ruling that said states cannot be forced by the federal government to expand Medicaid, each state must determine for itself whether it will participate in the Medicaid expansion under the ACA. The Medicaid expansion is funded by the federal government.
Each of these three states will roll-out a different plan to expand Medicaid over the next year or so. Below are details pertaining to each state’s plan and requirements.
Utah
Effective April 1, 2019, state residents were able to submit applications to the state Department of Workforce Services to enroll in Medicaid expansion. The expansion will allow individuals without dependents earning up to 100% of the Federal Poverty Level – about $12,492 for an individual or $25,752 for a family of four – to benefit from Medicaid, according to Utah’s Medicaid website.
Nebraska
Medicaid expansion in the state of Nebraska will go into effect in October 2020. State residents who meet the income criteria will be given an opportunity to enroll into basic or prime coverage. Additionally, state residents will need to work, provide for a family member, volunteer, be actively looking for work, or attend university or an apprenticeship if they wish to receive full care under the expansion, according to an article by Live Well Nebraska.
Idaho
State residents of Idaho will be able to obtain Medicaid if they meet the income criteria and are working a minimum of 20 hours a week. According to an article by the Idaho Statesman, a recent bill will now require “adults on Medicaid to work, train or volunteer at least 20 hours a week.” Some exemptions will apply for parents and college students.
More on Idaho’s Medicaid expansion can be found here.
For the 14 remaining states that have not adopted the ACA’s Medicaid expansion, roughly 4.4 million uninsured nonelderly adults could become eligible for Medicaid if these states elected to expand their programs, according to a study by the Kaiser Family Foundation. Another study cites that 15,600 deaths could have been averted if all 50 states implemented an expansion of Medicaid, according to a post by Vox. To see a map of the states that have expanded Medicaid programs, click here.
The continuing expansion of Medicaid is further evidence that the health care law is becoming entrenched. Roughly 77% of Americans are in favor of Medicaid expansion under the ACA.
As the popularity of the ACA seems to grow, employers need to recognize that the health care law is going to remain in place for the foreseeable future. A component of the law that continues to remain largely unchanged is the Employer Shared Responsibility Provision, also known as the Employer Mandate, which requires employers with 50 or more full-time employees and full-time equivalent employees to offer Minimum Essential Coverage (MEC) to at least 95% of their full-time workforce (and their dependents) whereby such coverage meets Minimum Value (MV) and is Affordable for the employee or be subject to IRC Section 4980H penalties.
By the year 2026, the IRS is projected to issue over $228 billion in ACA penalty assessments to employers identified as having failed to comply with the ACA’s Employer Mandate.
Employers who have been hoping that they can avoid complying with the ACA may want to rethink that strategy with the IRS intensifying its ACA enforcement efforts.
