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What you need to know about this year’s Medicaid changes

Cropped SingleCare logo By | Updated on May 19, 2020
Medically reviewed by Scott Dershowitz, LMSW, CMC

With the Medicaid system constantly being updated (if not overhauled), it can be difficult to keep up with the details of your coverage. Here’s what has changed in 2020. 

Medicaid is a federal and state program that assists with medical costs for people with limited income and resources who qualify. It is funded by Federal payroll taxes, general tax revenues, and beneficiary premiums to offer benefits not normally covered by other government assistance programs, including nursing home care and personal care services. Medicaid is often confused with Medicare (the federally administered, federally funded health insurance program for people 65 and older and some people with disabilities­), but they are very different. But because of Medicaid’s reliance on both the federal and state governments that change from one administration to the next, the program also has a tendency to change over time—making it difficult to know and understand the details of coverage and benefits.

Medicaid policies have undergone a number of changes since the Affordable Care Act (ACA) was passed in 2010, and as a result, many Americans who depend on Medicaid still don’t know if and how they’re affected, even 10 years later. That’s why we’re taking a look at some of the most recent Medicaid changes and up-to-date facts so you can make the best of your current medical situation.

What are the requirements to be eligible for Medicaid?

Currently, to qualify for Medicaid, you must financially meet the criteria (detailed below) as well as the following: 

  • Beneficiaries generally must be residents of the state in which they are receiving Medicaid. 
  • They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents. 
  • Some eligibility groups are limited by age, or by pregnancy or parenting status. 
  • Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups

Additionally, individual states have the option to establish a “medically needy program” for individuals with significant health needs whose income is too high to otherwise qualify for Medicaid under other eligibility groups. This requires that individual to “spend down.”

What are the latest Medicaid changes?

Because the Medicaid program is jointly funded by federal and state governments, there is often a significant amount of variability when it comes to eligibility and benefits from state to state. According to official Medicaid records, the federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP). Then, each state is responsible for operating its own Medicaid program within federal guidelines. States have a great deal of flexibility in designing and administering their programs. As a result, Medicaid eligibility and benefits can and often do vary widely from state to state.

The current state of eligibility and expansion

After the ACA was passed in 2010, eligibility for Medicaid was expanded to include more low-income qualifiers, up to 138% of the poverty line. That means those with an individual annual income of $16,753 or less and for a family of four with an annual household income of $34,638 or less qualifies for Medicaid coverage. So generally, the income limit in 2020 is $2,349 per month in most states and the asset limit is $2,000 for a single senior applicant. To verify this income, the state Medicaid agency places the burden of proof of monthly income on the applicant. Translation: Medicaid requires most applicants to provide all requested and necessary documentation to verify what is written in the application.

Currently states are allowed to either take part of the expansion or to opt out. As of April 2020, 35 states plus the District of Columbia have implemented the Medicaid expansion to serve poor and low-income adults. Those states include:

  1. Alaska
  2. Arizona
  3. Arkansas
  4. California
  5. Colorado
  6. Connecticut
  7. Delaware
  8. Hawaii 
  9. Idaho
  10. Illinois
  11. Indiana
  12. Iowa 
  13. Kentucky
  14. Louisiana   
  15. Maine
  16. Maryland
  17. Massachusetts
  18. Michigan
  19. Minnesota
  20. Montana
  21. Nevada
  22. New Hampshire  
  23. New Jersey
  24. New Mexico
  25. New York
  26. North Dakota
  27. Ohio
  28. Oregon
  29. Pennsylvania
  30. Rhode Island
  31. Utah
  32. Vermont
  33. Virginia
  34. Washington
  35. West Virginia

Expansion looks different for each state, as does implementation of the expansion. But one bottom line is that if your state has accepted and implemented the expansion, you may now qualify for Medicaid—even if you had not in the past. For a detailed look at your state’s implementation, check out the Kaiser Family Foundation’s interactive map. As of now, 14 states have not adopted the expansion. For those states, if you fall at or under the Federal Poverty line for your household size ($12,760 for an annual individual income), you still may qualify for Medicaid coverage. 

Some states now have work requirements

Some states are now requiring proof of work for eligibility and retention of Medicaid benefits. According to the Kaiser Family Foundation, the Centers for Medicare and Medicaid Services (CMS) issued guidance under the Trump administration for state Medicaid waiver proposals that would impose work requirements in Medicaid as a condition of eligibility. These waivers require beneficiaries to verify their employment, their active search for a job, and/or job training programs for a certain number of hours per week to receive or retain Medicaid coverage. Details about the specific number of hours, approved activities, exemptions, and the reporting process vary by each state that is implementing a waiver. 

It’s worth noting that work requirement waivers led to 17,000 people in Arkansas losing coverage in 2018. 

Is Medicaid changing in 2020?

In January, the Trump administration announced that it would allow states more freedom to change spending caps and drug coverage under Medicaid for many poor adults, a major shift that—according to the New York Times—gives states the option of reducing health benefits for millions who gained coverage through the program under the Affordable Care Act. This new plan is called “the Healthy Adult Opportunity,” and­—if implemented by states—would allow states to cover fewer drugs for enrollees. This would be a complete policy change from what is currently in place, which declares that states must cover all medically necessary drugs. And although this reduction for Medicaid would maintain a minimum level of coverage for individuals under the guidelines of the Affordable Care Act’s 10 categories of “essential health benefits,” coverage would be much thinner than it is now. States would be able to decide who exactly to cover and reduce or completely omit traditional Medicaid benefits—including long-term care, transportation to medical appointments, and retroactive coverage (aka, “retro” coverage) for people who received care in a timespan of 90 days before they qualified for Medicaid. If these changes are carried out in 2020, Medicaid and affordable access to health care will look much different. 

Did President Trump make changes to Medicaid amid the coronavirus outbreak?

The global coronavirus pandemic has taken a massive toll on every aspect of our lives, including access to health care. And Medicaid policies are seeing changes, too. Nebraska will be the 37th state to adopt Medicaid expansion, but it hasn’t been implemented yet. Through the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which President Trump signed into law on March 27, more federal funding will be allocated to expansion states than nonexpansion states. Medicaid expansion states will receive $1,755 in federal funding per state resident in comparison to $1,198 per resident of nonexpansion states, according to calculations done by The Commonwealth Fund.

Additionally, diagnostic testing for COVID-19 is covered by Medicaid at no cost to patients—but there is currently no federal mandate that treatment for COVID-19 be covered at no cost to patients. It’s a little confusing, but some states have indicated that they are waiving cost sharing associated with COVID-19 testing and/or treatment. In public statements, federal officials have indicated insurance companies who provide coverage through Medicaid have agreed to cover all COVID-19 testing without cost sharing and to ensure treatment is fully covered, according to KFF.

Current issues with Medicaid

Records show that the federal government generally pays between 50% and 77% of each state’s total Medicaid costs. But for the costs of adults who qualified for Medicaid under the Affordable Care Act, that number is much higher: 90%. Reducing eligibility, drug coverage, and increasing state government’s freedom to dictate the finer points of Medicaid programs is an effort to decrease that spending. But, that can lead to thousands—if not millions—of Americans losing access to affordable health care. There are also additional disadvantages for beneficiaries of Medicaid, including the limited choices and coverage of care, physicians, medications, and long-term care facilities.

How to save on prescriptions with Medicaid

While you can’t use SingleCare and Medicaid benefits at the same time, you can use SingleCare if our prices are lower than Medicaid or if a prescription isn’t covered by your benefits. When you use your SingleCare card, the pharmacy processes it instead of your Medicaid card, not in conjunction with your Medicaid card. SingleCare can help you save up to 80% on prescription medications—reducing drug costs so you have more money left for your other essential expenses. All you have to do is visit our website, search for your medication, and text the Rx card to yourself or print it immediately—both versions work at the pharmacy. You can learn more about using SingleCare along with your Medicaid benefits here.