Some states expanding Medicaid eligibility through exchange marketplace

Some states that initially decided not to expand Medicaid eligibility guidelines for individuals earning up to 133 percent of federal poverty guidelines as permitted under the Patient Protection and Affordable Care Act are now opting to do so. But instead of directly expanding their existing Medicaid programs, the states want to integrate broadened Medicaid eligibility into their health benefit exchange marketplaces. And they want to do so with some economic incentives for enrollees.

The Washington Post’s Wonkblog reports Iowa joins Arkansas in obtaining a waiver from the U.S. Department of Health and Human Services to use federal dollars funding the Medicaid expansion to subsidize the premiums for commercial plans sold on the exchange marketplace. Iowa’s Marketplace Choice includes a wellness component that waives plan premiums for plan years 2014-16 if participants undergo annual health screenings and follow a doctor-directed wellness regimen.

On December 6, 2013, Pennsylvania submitted its waiver application to the federal government. The Keystone State’s proposed 5-year Healthy Pennsylvania program that would similarly allow those age 21 to 65 earning up to 133 percent of federal poverty to purchase commercial coverage on that state’s exchange. Enrollees earning 50 percent of federal poverty and greater would pay modest premiums that could be reduced with incentives for healthy behaviors and engaging in ongoing work search activities.


Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email or call 530-295-1473. 

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Frederick Pilot

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