2014 Medicaid changes help some, hurt others [Orlando Sentinel]

Oct. 17--For the poorest Floridians who rely on Medicaid for their health care, some big changes are coming in the new year that could affect whether they still qualify.

Others who currently don't get Medicaid may find that the new rules allow them to sign up.

The changes are all part of the Affordable Care Act and affect residents too poor to get a tax break on premiums through the health-care exchange.

So whether you apply this year or next could make a big difference.

"If you qualify now but won't under the new guidelines, sign up before Jan. 1," said Greg Mellowe, policy director of Florida CHAIN, a nonprofit whose mission is to make sure every Floridian has health coverage. "Conversely, if you don't qualify for Medicaid now, don't give up. Try again in the new year."

Currently, to qualify for Medicaid in Florida, nonworking parents are eligible if their monthly income is 19 percent of the federal poverty level or less, which for a family of three is about $3,700 a year, said Lawayne Salter of the Florida Department of Children and Families.

A working-parent household needs to make less than 50 percent of the poverty level, about $9,700 a year for a family of three, he said.

That's about to change.

Under the new federal law, which will apply in all states, the working-vs.-nonworking distinction goes away. And the income eligibility threshold for all families will be a universal 35 percent of poverty level, Salter said. For a family of three that would be just less than $6,800 a year.

The "asset test" for parents will also end come Jan. 1. Currently, if an individual has more than $2,000 in assets, such as money in a savings account or a car, that would be factored into eligibility, Salter said.

For example, if a single mother is unemployed but has $2,500 saved, she can't qualify for Medicaid until she's spent that down to $2,000, Mellowe said.

In 2014, "we won't count any of that," Salter said. Only taxable income -- earned and unearned -- will be considered. Technically, that means a family could have a large bankroll and still qualify.

And -- in what could be a big boost for some -- child support will no longer count toward the income limit, Mellowe said.

The new eligibility rules could have a crucial impact on the 763,890 low-income Floridians -- one in five uninsured residents -- who will fall into the new coverage gap, according to an analysis released Wednesday by the Kaiser Family Foundation.

This "doughnut hole" was inadvertently created last year when the Supreme Court decided that states could not be required to expand Medicaid. Florida is among 26 states that opted not to expand its Medicaid coverage, said Ron Pollack, executive director of Families USA, a health-advocacy nonprofit.

Ed Haislmaier, senior research fellow in health policy at the Heritage Foundation, a conservative think tank in Washington, doesn't think government programs are the best solution.

"The philosophy behind the Affordable Care Act is that if everyone had insurance, all would be well," he said. "You have to be careful not to buy into the worldview that starts from the presupposition that if all your health care was paid for by somebody else, then everything would be fine."

The intention behind the Medicaid changes is to streamline the enrollment process nationwide to make it easier for folks to connect with coverage options, said Samantha Artiga, analyst for the Kaiser Family Foundation.

By applying more-uniform standards electronically, those processing applications can get faster answers about coverage. In Florida, the changes should allow more people to be eligible for Medicaid, said Mellowe, though it will cause others to become ineligible.

"I don't anticipate that we will lose a lot of individuals as a result of the change," Salter said.

Florida will continue to process Medicaid applications for those who apply in 2013 using this year's rules, Mellowe said. A person who qualifies now but would not qualify next year will continue to receive Medicaid coverage for at least several months of the new year.

The earliest the state would send out a notice of ineligibility would be April 1, Salter said. That person's coverage wouldn't end for at least a month after that.

"The biggest message for consumers is not to assume," Salter said. The eligibility laws are complicated and changing. Look at the information, then see a counselor about eligibility. Even if you're not eligible, they can help you find out what's available outside Medicaid."

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Medicaid changes

THIS YEAR: A working family of three with a household income of $805 a month would be making less than 50 percent of the federal poverty level, which is $1,628. Thus, under today's law, the family would be eligible for Medicaid

NEXT YEAR: The same working family of three with an income of $805 a month, or 49 percent of the poverty level, would not be eligible because its income would be over the 35 percent threshold. For that same family to be eligible, the monthly income could not exceed $567.

SOURCE: Florida Department of Children and Families

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