Although all poor (i.e., below 100% of the federal poverty level, FPL) American children and pregnant woman are eligible for Medicaid or the State Children's Health Insurance Program (CHIP), other populations' upper-income eligibility threshold for Medicaid is often well below poverty. In some cases, individuals are ineligible for Medicaid regardless of their income. Some health reform proposals include provisions to expand traditional Medicaid—to 100% of poverty, for example—regardless of whether one is a member of a covered group, such as children, pregnant women, the aged, and the disabled. This report briefly describes two key aspects of current Medicaid eligibility—(1) categorical eligibility (i.e., membership in a covered group) and (2) income eligibility. The report then discusses some policy and legislative considerations in expanding mandatory Medicaid eligibility to 100% of poverty (regardless of category) through federal legislation. The upper-income threshold for AFDC eligibility in 1996 ranged across states from 11% to 68% of poverty. LPRs who have been in the country for less than five years are generally ineligible for Medicaid, although there is a new option for states to cover such children and pregnant women under CHIP.
All poor American children and pregnant woman are eligible for Medicaid or the State Children's Health Insurance Program (CHIP), although millions are not enrolled. However, some other populations' upper income eligibility threshold for Medicaid is often well below the federal poverty level. For working parents of dependent children, for example, the median Medicaid upper income eligibility threshold among the states is 68% of poverty—less than $10,000 a year for a single parent with a child. (For parents who are not working, the median Medicaid upper income eligibility threshold among the states is even lower, at 41% of poverty—less than $6,000 a year for a single parent with a child.) Adults under age 65 who are not disabled, not pregnant and not custodial parents of dependent children—often referred to as "childless adults"—are generally ineligible for Medicaid, regardless of their income.
Some health reform proposals include provisions to expand traditional Medicaid—to 100% of poverty, for example—regardless of whether one is in a covered "category," such as children, pregnant women, the aged or disabled, as generally required for Medicaid coverage today. This report briefly describes current Medicaid eligibility and presents some policy and legislative considerations if Congress decided to expand mandatory Medicaid eligibility to 100% of poverty through federal legislation.