Info for Residents in States that Are Not Expanding Medicaid

Family Voices Indiana shares this article since Indiana is a state that did not expand Medicaid. We encourage you to talk to a navigator before March 31 about your options.

By Elaine Saly and Zachary Baron

This post was written by Elaine Saly, Health Policy Analyst, Families USA, and Zachary Baron, Senior Health Policy Analyst, Enroll America.

Enrollment assisters and stakeholder organizations are working tirelessly to help consumers enroll in health coverage that meets their needs and budgets. But for enrollment assisters working in states that have not yet expanded Medicaid, it isn’t always possible to find an affordable health coverage option. Some people will not be able to get financial help to purchase health insurance through the marketplaces or access low- or no-cost coverage through Medicaid.

Specifically, adults with incomes below 100 percent of the federal poverty level (FPL) for 2013($11,490 for an individual and $23,550 for a family of four) who don’t currently qualify for Medicaid in their state will not be able to get financial assistance to purchase health insurance through the marketplace. And if their state has not opted to expand Medicaid, they will remain unable to afford health insurance.

Fortunately, there are important steps enrollment assisters can take — beyond making referrals to local organizations or programs that may be able to help with the cost of coverage — to help these individuals and their families get covered. Here’s how:

Step 1: Help individuals seeking health insurance complete their application for marketplace coverage — even if they can’t get financial help now.

Consumers who apply for coverage, even if they can’t get financial help now, will receive important protections:

·         They will receive a certificate of exemption from the marketplace. Individuals who can get an exemption will not pay a fine at the end of the tax year if they do not have health insurance and otherwise have to file taxes. The certificate of exemption will also allow these individuals to enroll in a marketplace plan with financial help later in the year if their income increases above 138 percent of FPL for 2014 ($16,105 for an individual and $32,913 for a family of four).

·         They may be able to enroll in a catastrophic plan, which will provide limited, low-cost health coverage. This will allow them to switch to another marketplace plan if their income increases above 100 percent of FPL later in the year.

·         Their children may be eligible for low- or no-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP), even if the adults are not able to get covered.

Step 2: After helping consumers fill out the application for marketplace coverage, provide consumers with information about next steps. 

Between March 31 and November 15, 2014, when the next open enrollment period begins, people will only be able to enroll in a health plan through the marketplace if they are eligible for a “special enrollment period.” Individuals will qualify for a special enrollment period if they experience certain life events and report these to their state’s marketplace.

Individuals who don’t have access to affordable coverage before March 31, 2014 will be eligible for one of these special enrollment periods if they experience a life event (like getting married or having a baby). Only having an increase in income will not make someone eligible for a special enrollment period. After March 31, 2014, people without coverage must already have an exemption from the marketplace in order to qualify for a special enrollment period when their income increases.