Medicaid Eligibility by Income

Medicaid is a critical source of insurance for women: ten percent of women who are not elderly are covered by Medicaid. (1) While federal law requires states to cover specific categories of low-income adults, states may expand the pool of people covered by Medicaid, particularly by raising the income level at which people are eligible. (2) The Report Card examines three ways in which Medicaid coverage can be expanded by income. First, states can expand Medicaid coverage for pregnant women, a policy that has contributed to the nationwide increase in women receiving prenatal care in the first trimester. (3) Second, states can raise Medicaid income eligibility for working poor families. Currently, over 80% of the uninsured are in working families. (4) Third, states can expand income eligibility for low-income elderly and disabled populations, thereby supporting this crucial source of additional coverage for six million Medicare beneficiaries and for 8 million disabled individuals. (5)

Data Points for this Issue:

Pregnant Women
Working Parents
Aged and Disabled

Pregnant Women

	Strength Of Policy 2007	Change From 2004
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Meets Policy	17
Limited Policy	26
Weak Policy	0
No/Harmful Policy	8
Better	3
Worse	1
Same	47

Does the state Medicaid program cover pregnant women with incomes at or above 200 percent of the 2006 FPL?

States receive a "meets policy" when they set the Medicaid qualifying income level for pregnant women at or above 200 percent of the FPL. States receive a "limited policy" when they set the eligibility between 133 percent and 200 percent. States receive a "no policy" if they do not raise the income eligibility levels above 133 percent, which is the federally set minimum.

Data Source: Medicaid Eligibility by Income: Pregnant Women (%FPL), 2006.

The Henry J. Kaiser Family Foundation, "Income Eligibility Levels for Pregnant Women Applying for Medicaid by Annual Income and as a Percent of Federal Poverty Level (FPL) 2006," available at http://www.statehealthfacts.org/comparetable.jsp?cat=4&ind=206.

Working Parents

	Strength Of Policy 2007	Change From 2004
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Meets Policy	4
Limited Policy	19
Weak Policy	0
No/Harmful Policy	28
Better	2
Worse	5
Same	44

Does the state Medicaid program cover working parents with incomes at or above 200 percent of the 2006 FPL?

States receive a "meets policy" when they expand their Medicaid income eligibility requirements to cover parents with incomes at or above 200 percent of FPL. States receive a "limited policy" when they expand the Medicaid eligibility over 74 percent but below 200 percent of FPL. States receive a "no policy" if they fail to raise these requirements beyond 74 percent of FPL.

Data Source: Medicaid Eligibility by Income: Working Parents (%FPL), 2006.

The Henry J. Kaiser Family Foundation, "Income Eligibility for Parents Applying for Medicaid by Annual Income as a Percent of Federal Poverty Level (FPL), 2006," available at http://www.statehealthfacts.org/comparetable.jsp?ind=205&cat=4.

Aged and Disabled1

	Strength Of Policy 2007	Change From 2004
ALABAMA
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING

Meets Policy	15
Limited Policy	0
Weak Policy	0
No/Harmful Policy	36
Better	0
Worse	0
Same	0

1. The 2007 Report Card uses a different source for this indicator than in 2004, therefore there is no comparison to 2004.

Does the state Medicaid program cover the "aged and disabled" with incomes at or above 100 percent of the 2006 FPL?

States demonstrate a commitment to the aged and disabled when they implement the option in the Omnibus Budget Reconciliation Act of 1987 (OBRA '86) (Pub. L. 100–203, 101 Stat. 1330) and expand income eligibility to or above 100 percent of FPL. States that have implemented the OBRA '86 option receive a "meets policy." States receive a "no policy" if they have not implemented the OBRA '86 option.

Data Source: Medicaid Eligibility by Income: Aged and Disabled (%FPL), 2001.

The Henry J. Kaiser Family Foundation, "Income Eligibility Levels for Other Medicaid Enrollment Groups as a Percent of Federal Poverty Level," available at http://www.statehealthfacts.org/comparetable.jsp?ind=207&cat=4.

1. The Henry J. Kaiser Family Foundation, "Women’s Health Insurance Coverage," February 2007, available at http://www.kff.org/womenshealth/upload/6000_05.pdf.

2. 42 U.S.C. §§ 1396-1396v; 42 C.F.R. Ch. IV; 45 C.F.R. Subtitle A.

3. U.S. Department of Health and Human Services, Healthy People 2010, 2^nd ed. (Washington: U.S. Department of Health and Human Services, 2000), 16-28, available at http://www.health.gov/healthypeople (reporting a rise in the number of women entering prenatal care in the first trimester from 75.8% in 1990 to 82.5% in 1997).

4. Kaiser Commission on Medicaid and the Uninsured, "The Uninsured and Their Access to Health Care," October 2006, available at http://www.allhealth.org/BriefingMaterials/The-Uninsured-and-Their-Access-to-Health-Care-Oct-2004-614.pdf.

5. Low-income elderly are referred to as "aged" in the Medicaid statute, where they are defined as being 65 or older. "Disability" is defined as "a physical or mental impairment that keeps a person from performing any 'substantial' work, and is expected to last 12 months or result in death." 42 U.S.C. §§ 1396d(a)(iii), 1396d(a)(viii); Kaiser Commission on Medicaid and the Uninsured, "The Medicaid Program At A Glance", March 2007, available at http://www.kff.org/medicaid/upload/7235-02.pdf.