Each health reform bill in Congress achieves part of its insurance coverage expansion by increasing eligibility for Medicaid.
The latest health reform proposal, from Senate Finance Chairman Max Baucus, D-Mont., would expand Medicaid to all U.S. citizens who earn up to 133 percent of the federal poverty level (which is $14,400 for an individual and $30,000 for a family of four), beginning in 2014. Those earning 100 percent to 133 percent of poverty could take Medicaid or a private health insurance plan offered through a health insurance exchange. (The bill approved by several House committees also expands coverage to 133 percent of poverty, while the bill approved by the Senate Health, Education, Labor and Pensions Committee expands eligibility to 150 percent of poverty.)
Because Medicaid is funded jointly by the federal and state governments, there is concern that expanding the program would put significant new financial pressure on already tight state budgets. Under the Baucus proposal, the federal government would pick up more of the tab than it does now for newly eligible people (as much as 95 cents of every dollar it costs to cover these people in some areas).
What should the state's contribution be? What level of out-of-pocket payments should be required for beneficiaries, and what benefits should they receive? How should providers be paid?