By Christopher Plein, Ph.D.
Through my work, I often give presentations on topics relating to federal and state health policies and programs. Some of these presentations focus on the study of these topics, others on their application. One key takeaway is that health related policies are in constant development, the other is that there is great variation in policies and programs across the states. For me, among the most important audiences are those professionals who help individuals and families who might need to access healthcare services. A key factor in helping others is understanding the health policy and program landscape.
Health Care Coverage & Access to Medicaid
One of the most significant public programs providing health care coverage and access is Medicaid. A joint state and federal program that was established in 1965 primarily for very low-income families, it has evolved over time to cover many lower income individuals and families as well as those with specific health and care needs. Approximately 21 percent of the U.S. population is covered through Medicaid, according to the Kaiser Family Foundation.
Medicaid also has a place in providing health coverage for service members, veterans, and their families. According to statistics provided by the federal Medicaid and CHIP Payment Access Commission, an estimated 867,000 individuals receiving the TRICARE benefit were also dually eligible for Medicaid in 2018. Of these, an estimated 220,000 were children. Among veterans, approximately 960,000 received Medicaid coverage in 2018.
Apart from providing health insurance coverage for lower income individuals and families, Medicaid can be crucial to helping those who are eligible for coverage due to specific care needs and economic circumstances. Through Medicaid, home and community-based services (HCBS) help to provide care for seniors and adults with physical disabilities, those who have intellectual and developmental disabilities, those with traumatic brain injuries (TBI), those with mental illness, as well as those with other conditions and needs. They are often referred to as Medicaid “waiver” services or programs due to the fact that states require federal approval before offering them.
Different Across States
However, as I always share with my audiences, Medicaid is not the same from state to state. This has been the case since the program began in the 1960s. As a result of the Affordable Care Act of 2010 (ACA), states were given the discretion to expand eligibility for adults who would not otherwise qualify due to income. The ACA allows states to raise income-based eligibility to 138 percent of the federal poverty rate. According to federal sources, in 2022 this amounts to an income of $18,754 for an individual. This amount increases based on family size, so that for a family of two it is $25,268, and for a family of three it is $31,781. Thirty-eight states plus the District of Columbia have expanded Medicaid, leaving eleven states that have not done so. Among the states that have not expanded Medicaid are Florida, Georgia, North Carolina, and Texas – each of which have large active duty and veteran populations.
State to state differences are seen more starkly with various Medicaid HCBS waiver programs. According to the Kaiser Family Foundation, in 2020 approximately one-half of the states provided TBI services through Medicaid waiver programs. Eleven states had implemented mental health services programs through the waiver option. In contrast, almost all states provided intellectual and developmental disability services under waiver programs. Adding further complexity is that eligibility requirements to participate in waiver programs may vary from state to state. Unfortunately, excess demand may mean that individuals and families may have to wait to gain access to services. The types of services provided under waiver programs may also vary from state to state.
What does this all mean in practical terms? It means that those in active duty status and those nearing separation or retirement may want to take Medicaid program differences into account in their planning. To facilitate military career and life transitions and relocations, family support professionals both within and outside the Department of Defense and the service branches can help provide information and resources for informed decision making.
Because the Medicaid landscape is rapidly changing, it is helpful to access information and updates on developments and trends relating to Medicaid and other programs. Our OneOp programs and resources help to provide relevant information through blogs and webinars. These provide overviews of program features and developments, as well as helpful links to other resources for review and information.
Our webinars and blogs are archived and are easily accessible. As policy developments continue to unfold, we anticipate offering further updates and discussions of Medicaid and other important health policies and programs. In the meantime, I am looking forward to getting on the road again to meet with others to discuss Medicaid and its relationship to individuals and families in both the military and civilian context.
HealthCare.Gov. 2022. Federal Poverty Level (FPL). https://www.healthcare.gov/glossary/federal-poverty-level-fpl/
Kaiser Family Foundation. 2022. State Health Facts: Health Insurance Coverage of the Total Population. https://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&selectedDistributions=medicaid&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
Kaiser Family Foundation. 2022. State Health Facts: Medicaid Section 1915(c) HCBS Waiver Participants by Type of Waiver. https://www.kff.org/health-reform/state-indicator/participants-by-hcbs-waiver-type/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
Medicaid and CHIP Payment Access Commission. 2020. June 2020 Report to Congress on Medicaid and CHIP (June), pp. 85, 87. https://www.macpac.gov/publication/june-2020-report-to-congress-on-medicaid-and-chip/
U.S. Department of Defense. Defense Health Agency. Warrior Care Recovery Coordination Program. 2022. Recovery Coordination. https://warriorcare.dodlive.mil/Care-Coordination/recovery-coordination/#:~:text=The%20Recovery%20Care%20Coordinators%20work,education%2C%20employment%2C%20or%20housing.