Kansas Insurance Commissioner Sandy Praeger says it will be hard to explain to thousands of Kansas residents why they are too poor to qualify for health insurance benefits under the Affordable Care Act.
Because Kansas has refused to accept the federal expansion of Medicaid benefits, a big gap in insurance coverage will open up in the state starting in January 2014. The federal ACA provides tax credits to help people pay for health insurance, but the act provides those credits only to people with incomes equal to 100 percent to 400 percent of the federal poverty level. That’s because the act assumes that people below that income level would be covered by expanded Medicaid benefits offered at the state level.
However, Kansas has refused to participate in the Medicaid expansion, even though the federal government would have paid 100 percent of the cost for that expansion for three years and 90 percent after that. Instead, Kansas is maintaining its existing Medicaid eligibility standards, which are some of the most restrictive in the country. Adults at any income level don’t qualify for the Kansas Medicaid program, known as KanCare, unless they are disabled. Families with children qualify for KanCare only if their incomes are below 35 percent of the federal poverty level. That’s $6,000 to $8,000 a year for a family of four.
That leaves tens of thousands of Kansans in a gap in which they are” too rich” to qualify for KanCare but too poor to qualify for tax credits to help them buy health insurance.
“The message that they’re too poor to qualify is not one they’re going to understand,” Praeger said in a recent radio interview. “They’re going to say, ‘What do you mean I’m too poor? You mean I make too much money?’ No, you’re too poor, because if you don’t make at least 100 percent of the federal poverty level, you’re not eligible because Kansas didn’t do the Medicaid expansion.”
An analysis released last month by the Kaiser Commission on Medicaid and the Uninsured says about 58,000 Kansans will fall into the coverage gap; a Kansas Health Institute brief released in January puts the estimate at about 88,000.
The Kaiser Commission estimates that expanded Medicaid in Kansas would provide insurance coverage to 144,000 additional Kansans and bring $5.3 billion in additional federal Medicaid funding to the state between 2013 and 2022.
It’s not a lot of comfort, but, according to the Kaiser Commission, Kansas is one of 21 states that aren’t currently moving forward with expanded Medicaid and will experience similar large gaps in medical coverage. Perhaps those other states have some advice for Kansas on how to explain to people that they are “too poor” to qualify for health insurance assistance.