Medicaid is a collection of programs that serve different groups. Each group has different eligibility criteria. Some groups have asset limitations. Other groups allow for substantially higher income limits than others. Some groups get a full benefit package while other people are served by Medicaid acting as a supplemental insurance policy to pay cost-sharing for Medicare. It is messy.
Let’s take an example from North Carolina for a hypothetical family of four. We will make this easy and assume decent to good health for everyone. Mom and Dad are both 40. Kid 1 just turned 6 and Kid 2 is 11 months old.
Dad loses coverage if family income goes over 41% Federal Poverty Level and/or assets are over $3000.
Mom loses full coverage if family income goes over 41% FPL and/or assets are over $3000 AND she loses limited post-partum coverage if family income goes over 196% FPL.
Kid 1 loses full coverage if family income goes over 133% FPL.
Kid 2 loses full coverage if family income goes over 210% FPL.
Kids 1 and 2 are eligible for CHIP (NC Health Choice) which has similar but sparser coverage benefits than Medicaid up to 211% FPL.
Why does this matter?
It is quite plausible that if one person in a household is determined to be no longer eligible for Medicaid, most, if not all, of the other members in the household can retain their eligibility. In states with Medicaid Expansion, an initial redetermination for a “legacy” Medicaid eligibility category may find that an adult is no longer eligible for that category but Medicaid Expansion is a second chance to maintain coverage with looser income and asset rules for a full benefit package.
Big big news on unwinding: CMS is making states who were conducting household-level determinations (rather than individual-level determinations) pause procedural terminations *and* reinstate coverage for affected people https://t.co/012OGOjvOy pic.twitter.com/HTf3lo1aMX
— Adrianna McIntyre (@adrianna.bsky.social) (@onceuponA) August 30, 2023
Different eligibility levels in a family for MedicaidPost + Comments (7)