Medicaid and Bleeding Disorders

Individual states make the determination
Author: Kadesha Thomas Smith and Marla Feinstein

Medicaid has long been regarded as the safety-net health insurance program for low-income individuals and families, seniors and those with disabilities. As the nation’s largest public health insurance program, it covers roughly 60 million people and is funded by federal and state dollars. The percentage of federal vs. state funding varies by state.

When the Patient Protection and Affordable Care Act (ACA) was signed into law in March 2010, it included a provision mandating all states to expand their existing Medicaid programs to include all US citizens up to age 65 with incomes below 138% of the federal poverty level, which is $14,856 per year for an individual or $30,675 for a family of four. This mandate was intended to expand eligibility primarily to childless adults, a population that does not qualify for coverage in most states. Currently, Medicaid covers people based on the state’s income eligibility criteria.

In June 2012, the US Supreme Court ruled that states cannot be mandated to expand their Medicaid programs. However, states that choose to expand will receive additional federal funding to support new enrollees.

Starting in January 2014, members of the bleeding disorders community whose incomes were previously ­considered too high for Medicaid may be eligible. “Expanding Medicaid could potentially allow more ­vulnerable members of the population to participate, because eligibility will not be linked solely to disability status,” says Michelle Rice, director of public policy for the National Hemophilia Foundation (NHF).

After age 18, childless adults are too old to qualify for the state’s children’s health insurance programs for low-income families. To remain on Medicaid, they must meet the state’s criteria for disability. “Meeting a state’s definition of disability is not always easy, and often varies from one instance to another,” says Rice. “Medicaid expansion has the potential to prevent individuals from falling through the cracks.”

As of March 2013, 25 states plus the District of Columbia planned to expand their Medicaid programs. Two others are leaning toward it, according to The Advisory Board Company, a healthcare research and consulting firm. Fourteen states have chosen not to expand coverage, and the rest are undecided. The federal government has stated it will finance a majority of the cost of expansion, including 100% of the costs in 2014–16 for individuals “newly eligible” (not previously eligible in their state). Beginning in 2016 this amount will be reduced yearly, ultimately ending at 90% by 2020.

Expanding Medicaid would allow more people with bleeding disorders to access coverage. “There are clear differences in healthcare patterns between people with the same illnesses,” says Rachel Garfield, PhD, senior researcher and associate director at the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured. “People with Medicaid are more likely to see a doctor, less likely to report problems,” she says. “Coverage makes a difference.”

NHF’s public policy team often receives calls from individuals who either forgo treatment or use the emergency room as a primary provider, due to their inability to access healthcare coverage. Neither situation is recommended or ideal.

However, some Republican governors argue that simply expanding Medicaid without major Medicaid reform may not improve access to care and may make it even more difficult­ for states to provide adequate care. “Expansion without reform is not responsible and would bust the state budgets,” states a letter sent to President­ Barack Obama by GOP governors Bob McDonnell of Virginia and Bobby Jindal of Louisiana.

“The money piece is significant in certain states,” says Amy Lischko, DSc, associate professor of public health and community medicine at Tufts University School of Medicine in Boston. Healthcare already competes with other priorities for state funding, including education and public works. “Even though the federal government is paying most of the bill, many states are strapped for funding following the recession.”

Throughout 2013, states will be weighing the options and making a decision about expanding their Medicaid programs. Rice foresees some of the opposing states changing their decisions. “States will be facing pressure not only from patient populations, but also from hospitals to expand,” she says. Those that do not expand Medicaid will see costs rise elsewhere, Rice warns. “The care people do receive will be classified as uncompensated, which often makes care less affordable for everyone.”

People with bleeding disorders should keep a close eye on these changes. NHF’s public policy team will continue to keep you informed. Look for updates posted on NHF’s Web site and in eNotes, its electronic monthly newsletter.