Thursday, June 18, 2020

Misinformation about Medicaid on state and federal websites

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In one of the many charming technical wrinkles that grace our healthcare system, the income threshold for Medicaid eligibility in states that have enacted the ACA Medicaid expansion (yes, long sentence, that's the point...) is 133% of the Federal Poverty Level (FPL)... except it's actually 138% FPL, thanks to a 5% deduction from an applicant's Modified Adjusted Gross Income (MAGI) mandated by the ACA.

Got that? Good. And who cares? What matters is the monthly income threshold in dollars for households of different sizes, against which people who think they may be eligible can check their income prior to deciding whether to apply.

Some government websites quote 133% FPL as the eligibility threshold for those rendered eligible by the ACA Medicaid expansion. That might not matter -- who knows what 133% FPL is? -- except that some state and federal sites take the trouble to convert that threshold to a monthly income. The wrong monthly income.

The actual monthly income thresholds for Medicaid eligibility in 2020 are $1,468 for an individual,  $1,983 for a couple, $2,498 for a family of three and $3,013 for a family of four.  Don't tell Connecticut; for childless adults, the state is quoting:

Those thresholds appear to be 135% FPL.

Arizona shows an outdated monthly threshold.  Michigan indulges in rounding off (without saying so) as well as lowballing. If you exercise the extraordinary navigating skills required to get from the state's omnibus benefits page or the Medicaid overview page to the page with eligibility information, you'll read:

That's wrong. The annual income thresholds are $17,609 for an individual and $36,156 for a family of four. Welcome to 2020, MIDHHS. P.S.,  annual income alone can be misleading -- Medicaid is based on current monthly income.* If you've earned, say, $15,000 before being laid off and your current unemployment check is $1,300**, you qualify. But you may assume otherwise if you're shown an annual income threshold. Someone please tell Indiana, and a bunch of other states.

Perhaps a newly unemployed, newly uninsured person anxious to find health coverage in a pandemic will find her way to, "the official benefits website of the U.S. government," which provides easy navigation by benefit type and state. Reliable, right? Well technically, sort of. But the site returns annual income thresholds at 133% FPL.  Here's what the site will yield in the Medicaid expansion states:

Sure, those numbers are "accurate" -- if you happen to have on tap the knowledge that you need to add 3.7% to account for the MAGI's discounting of 5% of your gross income.

If you lose employer-sponsored insurance (or, in some circumstances, even if it's available to you), determining your options and what subsidized government program may be available and suitable for you can be very complicated. But not always. About half of those who lose employer-sponsored insurance in the current crisis will qualify for Medicaid. For these 10-15 million people, enrollment should be straightforward. What they need, to get pointed in the right direction, is a chart like this, from the Maine Dept. of Health and Human Services Health Care Assistance page...

...and/or a screening tool like this, from the Ohio Dept. of Health:

Or this, available on

But many people, visiting many state websites, won't find this information. Many states seem to want people to start an application before they have a ballpark sense of what they may be eligible for. You can find Medicaid information on most ACA exchanges -- if you squint (and if you're not misdirected by information about Special Enrollment Periods, irrelevant to Medicaid, or by eligibility screening tools that prompt for annual rather than monthly income). If you're googling "Medicaid + STATE" or "health insurance + STATE," good luck. You may end up in a maze of pages -- say, a page about "Medicaid for adults" listing 12 programs, or a page describing everything but eligibility for adults based on income, or an "apply for Medicaid" page that doesn't tell you anything about how to apply.

And don't expect to find information about subsidized health insurance (Medicaid or marketplace) on, say, your state's unemployment insurance site. That's a bridge way too far for most state governments in the United States.

* Current monthly income is the primary qualifier for Medicaid eligibility. If monthly income is above the threshold, however, while annual income is below it, the applicant qualifies. will not recognize this eligibility, however -- it requires human intervention to apply for "gap" Medicaid. In the wake of tens of millions of sudden layoffs, the opposite scenario -- annual income above the threshold, current monthly income below it -- is likely to be more prevalent.

**  The $600/week supplementary unemployment insurance income provided by the federal CARES Act doesn't count toward Medicaid. Few if any state sites tell you that on their information pages; hopefully the applications themselves make this clear.

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