Article examines new challenges Federal Government will face when Medicaid eligibility expands in 2014

A new article released in the February 2011 issue of Health Affairs, co-authored by Benjamin Sommers, MD, PhD, of the Department of Health Policy and Management at the Harvard School of Public Health, and Sara Rosenbaum, JD, Chair of the Department of Health Policy and Hirsch Professor of Health Law and Policy at the George Washington University School of Public Health and Health Services, examines new challenges that States and the Federal Government will face when Medicaid eligibility expands in 2014, under the Patient Protection and Affordable Care Act (ACA).

Beginning in 2014, the new health reform law expands Medicaid's income eligibility level for non-elderly adults up to 133% of the federal poverty level, which equates to about $30,000 for a family of four. The ACA also provides premium subsidies to other qualified, non-Medicaid enrollees to help them afford purchasing commercial health insurance through the newly-created Health Insurance Exchanges. The authors point out that eligibility for both the new health reform premium subsidies and the Medicaid program are based on a person's income, which can often change over the course of a year, depending on a number of factors.

Using income fluctuation information gleaned from national survey data, the authors estimate that more than 35 percent of low-income adults with families whose income falls below 200 percent of federal poverty level will undergo at least one eligibility shift from Medicaid to an insurance exchange, or vice versa, within six months.

"Addressing transitions among sources of coverage represents one of the most important implementation challenges that lie ahead," said Professor Rosenbaum.

To help combat against breaks in coverage stemming from changes in income, the authors make suggestions on how to remedy this issue, including getting the Federal Government to certify insurance plans in the new Exchanges to serve both Medicaid enrollees and regular Exchange purchasers, among other options.

"Strengthening the safety net systems and creating an environment where sustainable health care is fostered, is important. As a school of public health, we are committed to working to help identify resources and strategies to help address the issues of coverage transitions for Americans," said Dr. Lynn Goldman, Dean, GW School of Public Health and Health Services. 

SOURCE The George Washington University Medical Center