As of late 2022, more than 84 million people were enrolled in Medicaid — a number that has steadily increased in recent years. Amid the pandemic, total enrollees climbed by 20 million people from 2020 to 2022 alone.
Meanwhile, the debate among lawmakers on further expanding Medicaid in some 11 states continues to evolve. Depending on where you reside, passage of such an expansion could mean you become newly eligible for Medicaid.
What is Medicaid?
Medicaid is a nationwide program designed to provide public health insurance for low-income individuals, including seniors and people with disabilities. Established in 1965, it serves today as the single-largest source of health coverage in the U.S.
Because Medicaid is jointly run by the federal government and state governments, its benefits — and your ability to qualify for them — can vary greatly depending on your state.
As a result, certain populations, even if they are living in poverty, may not be eligible for Medicaid. For example, in some states, a healthy, childless adult couple under age 65 with limited means may not qualify for health coverage through Medicaid if their state has not adopted Medicaid expansion.
What Is Medicaid Expansion?
Medicaid coverage across the country has evolved since the program was first created. Different states may employ different eligibility criteria, income limits, or application requirements.
In 2010, the Affordable Care Act (ACA) attempted to expand Medicaid coverage to adults between 18 and 65 with incomes below a certain level, regardless of their age, family status, or health. The ACA also sought to supply those whose incomes fell within specific limits with premium tax credits that would help them afford the purchase of a private insurance plan.
Yet, the Supreme Court ruled that the federal government could not force states to expand coverage. States can decide whether to expand Medicaid to cover more people. This has created a coverage gap: those who have incomes below 100 percent of the federal poverty level and who live in states that have opted against expanding Medicaid may not qualify for Medicaid, or for the premium tax credits.
Virginia Medicaid Eligibility
For older adults, most states provide Medicaid to those who receive Supplemental Security Income (SSI). In Virginia, if you’re approved for SSI, you must still apply for Medicaid to be found eligible. To be eligible for SSI, individuals must have low incomes, limited assets, and be unable to work due to a qualifying mental or physical impairment. Per the Kaiser Family Foundation, some states expand Medicaid to older adults and disabled people whose income surpasses the SSI limit but falls below the federal poverty level.
Fortunately, Virginia approved Medicaid Expansion effective January 1, 2019. To determine if you are one of the over 450,000 Virginians who have become eligible for Medicaid under expansion, complete the online application at www.commonhelp.virginia.gov, or call 1-855-242-8282 (TDD: 1-888-221-1590) Monday through Friday from 8:00 am to 7:00 pm and Saturday 9:00 am to 12:00 pm. The timing of expansion was fortuitous, as it occurred shortly before the pandemic in 2020.
VA Medicaid Income Limits
In states that have adopted expanded Medicaid, you may qualify if your household income lies below 133 percent of the federal poverty level, according to HealthCare.gov.
The income limits for Medicaid expansion in Virginia for 2023 are $1,677 per month for an individual, and $2,268 per month for a family of two. For each additional family member, add $591 per month to the income limit to determine eligibility. Unlike other Medicaid benefits in Virginia, there is no asset limit for Medicaid expansion.
Even if you discover that you are not eligible for Medicaid under expansion, please consult the online resources at enrollva.org (or call 1-888-392-5132) to determine other health insurance options that may be available to you in the Marketplace under the Affordable Care Act.
You may be able to qualify for Medicaid through the Medically Needy program if your state has established one. The Medically Needy program allows people to enroll in Medicaid when they have significant medical expenses. When they subtract their medical spending from their total income, they can qualify for Medicaid if their income, minus health care expenses, falls below a specified limit (which also varies by state).
Additional Resources to Determine Medicaid Eligibility
- The Benefits.gov Eligibility Checker will ask you questions regarding things like household income, number of dependents, and citizenship status to help you determine whether you might be eligible for Medicaid generally.
- The HealthCare.gov site can offer additional insights, including:
- Guidance on Health Insurance Marketplace applications
- Income calculators
- Premium tax credit information
- Q&A tool to determine eligibility for cost-sharing reductions
To find out whether you may be able to receive public health insurance through Medicaid, consult with a ThompsonMcMullan attorney.