Which Parents Would Still be Covered if Medicaid Expansion Goes Away?

Given discussions in Congress to eliminate the Medicaid expansion over time, the question has arisen as to which parents would still be covered if expansion went away. In the first year of ACA implementation, expansion states accounted for the majority of the estimated 1.1 million parents who gained coverage. And, in 2015, the uninsurance rate among parents in expansion states was 8.7% as compared to 16.2% in non- expansion states.

We have written frequently about the importance of parent coverage for children. Losing Medicaid expansion coverage for parents would be a major setback for children and families— exposing them to financial insecurity, worsening the health status of parents, and likely slowing down coverage gains for kids as well – due to a reverse “welcome mat” effect.

As Medicaid wonks know, not all parents would lose coverage if the expansion goes away because states are required to cover so-called “Section 1931” parents – of course assuming that this requirement is not eliminated by Congress! Section 1931 refers to the longstanding requirement that emerged during the “de-linking” of cash assistance from Medicaid, which required states to cover parents whose income falls below an income eligibility level. These thresholds are set very low with the median for all states hovering around less than half the poverty line (48% FPL). Four states that expanded Medicaid (Arkansas, Indiana, Louisiana, and West Virginia) have pre-ACA parent eligibility levels below 20% of the FPL. Arkansas wins the prize for the lowest pre-ACA parent eligibility at 16% FPL, or less than $3,300 annually for a family of three. (You can see your state’s 1931 eligibility levels in Table 5 here in our report with the Kaiser Family Foundation on eligibility and enrollment.) So any parent living in an expansion state whose income is above this level and below 138% of poverty would lose coverage, leaving many working parents with less health care, more financial burden, and added stress.