Panel Discusses Proposals To Expand Medicaid To Cover More Low-Income Adults

Main Category: Medicare / Medicaid / SCHIP
Article Date: 17 Sep 2008 - 8:00 PDT

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Panel members on Monday during an event sponsored by the Alliance for Health Reform said that Medicaid would require significant changes to expand coverage to low-income adults who currently do not qualify for the program, CQ HealthBeat reports. According to a report recently released by the AARP Public Policy Institute, low-income adults who do not qualify for Medicaid account for more than half of U.S. residents without health insurance.

Under current law, only pregnant women, individuals with disabilities, those who care for a dependent child and those older than age 65 qualify for Medicaid. States can apply for federal waivers to expand their Medicaid programs to cover other populations. However, according to Stan Dorn, author of the report and a research associate at the Urban Institute, the Medicaid waiver application process is difficult, and the federal government does not provide additional matching funds for states that cover other populations under their programs.

Proposals
Dorn outlined three proposals under which the federal government could expand Medicaid to cover low-income adults who currently do not qualify for the program. Under one proposal, the federal government could maintain the current waiver application process but remove budget neutrality requirements to allow states to receive additional matching funds, Dorn said.

Barbara Coulter Edwards, a principal with Health Management Associates and former director of the Ohio Medicaid program, raised concerns about whether states could afford the proposal. She said, "States have to balance budgets ... (and) Medicaid is countercyclical. When the economy is the worst, the demand is the greatest. In the last recession, several states began to back away from eligibility expansions they put in place because they had to balance their budgets."

Dorn said that the federal government also could replace categorical eligibility requirements for Medicaid with requirements based only on income. Panel members raised concerns that the proposal could result in the loss of Medicaid coverage for some groups, such as pregnant women.

Under a third proposal, the federal government could establish a new Medicaid eligibility category that would include all adults with incomes less than a certain level. Panel members raised concerns that the proposal would increase administrative work for states and require additional funds.

According to Nina Owcharenko, a senior policy analyst at the Heritage Foundation Center for Health Policy Studies, public support for such proposals likely would decrease in the event that they required tax increases. "People are concerned with the amount of taxes they have to pay," Owcharenko said, adding, "How much (are) Americans willing to pay for certain reforms?" (Nylen, CQ HealthBeat, 9/15).

A webcast of the forum is available online at kaisernetwork.org.

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