The State of Medicaid: Part 2

The State of Medicaid: Part 2

My state didn’t expand Medicaid… now what?

Imagine a world in which you take all the steps to get insured through the Marketplace and find out that you actually qualify for Medicaid coverage. Now imagine a world in which you qualify for Medicaid, but your state didn’t expand Medicaid coverage.

Well, technically, you were imagining the same world the whole time. As discussed in last week’s post, some states opted out of Medicaid expansion. In these states, people, such as myself, might find that they qualify for Medicaid but cannot actually receive it. Naturally, this can be stressful and create lots of confusing questions.

Can I just go without insurance?

Yes. You can technically just go without insurance. (But I think it’s pretty obvious why that isn’t the most ideal route.)

 

Will I be penalized for being uninsured?

Short answer:

No.

Long answer:

You’ve probably heard that those who choose to forgo health insurance will have to pay a yearly fee for their decision. And this is true.

But the key is the word “choose.” If you qualify for Medicaid but won’t receive it, you have essentially been forced to opt out of insurance– because even the least expensive insurance package is just out of your reach.

The ACA won’t penalize you for a choice you never made. If you’re in the camp of the uninsured Medicaid-qualifiers, you can apply for an exemption from any ACA-related fees. All you have to do to claim this exemption is this: on your tax return, select exemption code G, which lists you as a “Resident of a state that did not expand Medicaid.” This exemption will last the full year.

 

If I do go without insurance, can I get any healthcare services?

Yes. You can check to see if there’s a community healthcare clinic in your area. Like Medicaid, the ACA also increased funding for these clinics. While you still will have to pay for these clinics’ services, prices vary based on your income. So if you qualify for Medicaid in an unexpanded state, you will receive relatively affordable services at a community healthcare clinic.

 

Can I get a tax credit to make Marketplace coverage more affordable?

In short: not really.

While it’s obviously much more complicated than that, the gist of it is that you either qualify for Medicaid or you qualify for a premium tax credit. There are certain types of Medicaid coverage that do still allow for a credit, but they’re very specific and unhelpful for those seeking general health insurance (think tuberculosis-related care).

 

Do I have any other options?

Well, you could always apply through the Marketplace anyways! It doesn’t cost you anything to apply through the Marketplace, and there is some chance that you will qualify for Medicaid in your state and just don’t realize it.

If you really don’t qualify, you can still check the Marketplace to weigh your options. That’s what I did when I was in this situation. I ended up finding a plan that, while not ideal, was basically within my price range.

 

This is a very complicated issue, with several specific stipulations. Since I’m not an insurance professional, I highly recommend contacting someone like Carlos at CRC Capital Group Inc., and reading some of the following literature if you’re in this particular situation: THIS article, THIS information, and THIS explanation.