The Coverage Gap: Uninsured Poor Adults in States that
Do Not Expand Medicaid – An Update
Rachel Garfield and Anthony Damico
One of the major coverage provisions of the Affordable Care Act (ACA) is the expansion of Medicaid eligibility
to nearly all low-income individuals with incomes at or below 138 percent of poverty ($27,724 for a family of
three in 20151). This expansion fills in historical gaps in Medicaid eligibility for adults and was envisioned as
the vehicle for extending insurance coverage to low-income individuals, with premium tax credits for
Marketplace coverage serving as the vehicle for covering people with moderate incomes. While the Medicaid
expansion was intended to be national, the June 2012 Supreme Court ruling essentially made it optional for
states.
As of January 2016, 19 states were not expanding their programs. Medicaid eligibility for adults in states not
expanding their programs is quite limited: the
median income limit for parents in 2016 is just
44% of poverty, or an annual income of $8,840 a
year for a family of three, and in nearly all states
not expanding, childless adults remain ineligible.2
Further, because the ACA envisioned low-income
people receiving coverage through Medicaid, it
does not provide financial assistance to people
below poverty for other coverage options. As a
result, in states that do not expand Medicaid,
many adults fall into a “coverage gap” of having
incomes above Medicaid eligibility limits but
below the lower limit for Marketplace premium
tax credits (Figure 1).
This brief presents estimates of the number of people in non-expansion states who could have been reached by
Medicaid but instead fall into the coverage gap, describes who they are, and discusses the implications of them
being left out of ACA coverage expansions. An overview of the methodology underlying the analysis can be
found in the Methods box at the end of the report, and more detail is available in the Technical Appendices
available here.

Figure 1
Gap in Coverage for Adults in States that Do Not Expand
Medicaid under the ACA
as of October 2014
as of January 2016
44% FPL
$8,840 for parents
in a family of three
$11,770
for an individual
$47,080
for an individual


The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update
2

Nationally, nearly three million3 poor uninsured adults fall into the “coverage gap” that results from state
decisions not to expand Medicaid, meaning their income is above current Medicaid eligibility but below the
lower limit for Marketplace premium tax credits. These individuals would have been newly-eligible for
Medicaid had their state chosen to expand
coverage.
Adults left in the coverage gap due to current
state decisions not to expand Medicaid are spread
across the states not expanding their Medicaid
programs but are concentrated in states with the
largest uninsured populations. More than a
quarter of people in the coverage gap reside in
Texas, which has both a large uninsured
population and very limited Medicaid eligibility
(Figure 2). Twenty percent live in Florida, eleven
percent in Georgia, and eight percent in North
Carolina. There are no uninsured adults in the
coverage gap in Wisconsin because the state is
providing Medicaid eligibility to adults up to the
poverty level under a Medicaid waiver.
The geographic distribution of the population in the coverage gap reflects both population distribution and
regional variation in state take-up of the ACA Medicaid expansion. As a whole, more people—and in particular
more poor uninsured adults— reside in the South than in other regions.4 Further, the South has higher
uninsured rates and more limited Medicaid eligibility than other regions.5 Southern states also have
disproportionately opted not to expand their programs, and more than half (10 out of 19) of the states not
expanding Medicaid are in the South. These factors combined mean nearly 90% of people in the coverage gap
reside in the South (Figure 2).
The characteristics of the population that falls into the coverage gap largely mirror those of poor uninsured
adults. For example, because racial/ethnic minorities are more likely than White non-Hispanics to lack
insurance coverage and are more likely to live in families with low incomes, they are disproportionately
represented among poor uninsured adults and among people in the coverage gap. Nationally, 45% of uninsured
adults in the coverage gap are White non-Hispanics, 23% are Hispanic, and 28% are Black (Figure 3).
However, the race and ethnicity of people in the coverage gap also reflects differences in the racial/ethnic
composition between states moving forward with the Medicaid expansion and states not planning to expand.
Several states that have large Black populations (e.g., Florida, Georgia, and Texas) have not expanded Medicaid
under the ACA. As a result, Blacks account for a slightly higher share of people in the coverage gap compared to
Figure 2
TX
26%
FL
20%
GA
11%
NC
8%
Other
States that
Have Not
Expanded
Medicaid
35%
Note: Totals may not sum to 100% due to rounding.
Source: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion
decisions as of January 2016 and 2015 Current Population Survey data.
South
89%
Midwest
7%
Northeast
1%
West
3%
Distribution of Adults in the Coverage Gap, by State and
Region
Total = 2.9 Million in the Coverage Gap
Distribution By Geographic Region:
Distribution By State:


The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update
3

the total poor adult uninsured population. The racial/ethnic characteristics of the population in the coverage
gap vary widely by state, mirroring the underlying characteristics of the state population.
Nonelderly adults of all ages fall into the coverage gap (Figure 3). Notably, over half are middle-aged (age 35 to
54) or near elderly (age 55 to 64). Adults of these ages are likely to have increasing health needs, and research
has demonstrated that uninsured people in this
age range may leave health needs untreated until
they become eligible for Medicare at age 65.6
While half of people in the coverage gap report
that their health is excellent or very good, nearly
a fifth (18%) report that they are in fair or poor
health (Figure 3). These individuals have known
health problems that likely require medical
attention. Studies repeatedly demonstrate that
the uninsured are less likely than those with
insurance to receive preventive care and services
for major health conditions and chronic
diseases.7 When they do seek care, the uninsured
often face unaffordable medical bills.8
The characteristics of people in the coverage gap also reflect Medicaid program rules in states not expanding
their programs. Because non-disabled adults without dependent children are ineligible for Medicaid coverage
in most states not expanding Medicaid, regardless of their income, adults without dependent children account
for a disproportionate share of people in the coverage gap (76%) (Figure 4). Still, nearly a quarter (24%) of
people in the coverage gap are poor parents
whose income places them above Medicaid
eligibility levels. About a quarter of a million
uninsured children have a parent in the coverage
gap (data not shown). Research has found that
parent coverage in public programs is associated
with higher enrollment of eligible children,9 so
these children may be hard to reach if their
parents continue to be ineligible for coverage.
The share of people in the coverage gap who are
adults without dependent children (versus
parents) varies by state (see Table 1) due to
variation in current state eligibility. For example,
Maine covers all parents up to at least poverty, so
all people in the coverage gap in that state are
adults without dependent children.
Figure 3
White
45%
Black
28%
Hispanic
23%
Other
4%
19-24
years
24%
25-34
years
24%
35-54
years
35%
55-64
years
17%
Demographic Characteristics of Adults in the Coverage Gap
Total = 2.9 Million in the Coverage Gap
Distribution By
Age:
Distribution By
Race/Ethnicity:
Excellent
or Very
Good
50%
Good
32%
Fair or
Poor
18%
Distribution By
Health Status:
Note: Totals may not sum to 100% due to rounding.
Source: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion
decisions as of January 2016 and 2015 Current Population Survey data.
Figure 4
Parent
24%
Childless
Adult
76%
Parent Status and Gender of Adults in the Coverage Gap
Parent Status
Male
48%
Female
52%
Total = 2.9 Million in the Coverage Gap
Gender
Note: Totals may not sum to 100% due to rounding.
Source: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion
decisions as of January 2016 and 2015 Current Population Survey data.


The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update
4

Even though women are more likely than men to qualify for Medicaid in states not expanding their programs,
women account for slightly more than half (52%) of adults in the coverage gap (Figure 4). This pattern occurs
because women make up the majority of poor uninsured adults in states not expanding their programs.
The work status of people in the coverage gap
indicates that there are limited coverage options
available for people in this situation. More than
six in ten (62%) people in the coverage gap are in
a family with a worker, and half are working
themselves (Figure 5). While workers could
potentially have an offer of coverage through
their employer, nearly half of workers in the
coverage gap (48%) work for small firms (<50
employees) that are not subject to ACA penalties
for not offering coverage. Further, many firms do
not offer coverage to part-time workers. A
majority of workers in the coverage gap also work
in industries with historically low insurance
rates, such as the agriculture and service industries.
Nearly four in ten (38%) adults in the coverage gap are in a family with no workers. Since the Medicaid
expansion was designed to reach those left out of the employer-based system, and because people in the
coverage gap by definition are poor, it is not surprising that most are unlikely to have access to health coverage
through a job.
If states that are currently not expanding their
programs adopt the Medicaid expansion, all of
the 2.9 million adults in the coverage gap would
gain Medicaid eligibility. In addition, 1.8 million
adults who are currently eligible for Marketplace
coverage (those with incomes between 100 and
138% of poverty10) would also gain Medicaid
eligibility (Figure 6 and Table 2). Though most of
these adults are eligible for tax credits to
purchase Marketplace coverage,11 Medicaid
coverage may provide lower premiums or cost-
sharing than they would face under Marketplace
coverage.
A small number (a little more than 500,000) of uninsured adults in non-expansion states are already eligible
for Medicaid under eligibility pathways in place before the ACA. If all states expanded Medicaid, those in the
Figure 5
No worker
38%
Part-time
worker
21%
Full-time
worker
41%
Notes: Industry classifications: Agriculture/Service includes agriculture, construction, leisure and hospitality services, wholesale and retail trade.
Education/Health includes education and health services. Professional/Public Admin includes finance, professional and business services,
information, and public administration. Manufacturing/Infrastructure includes mining, manufacturing, utilities, and transportation. Totals may not
sum to 100% due to rounding.
Source: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion decisions as of
January 2016 and 2015 Current Population Survey data.
48%
55%
6%
14%
46%
17%
8%
6%
Work Status of Adults in the Coverage Gap
Family work status :
Total = 2.9 Million in the Coverage Gap
Firm size and industry among those working:
<50 employees
50-99
employees
100+
employees
Agriculture/
Service
Education/
Health
Professional/
Public Admin
Manufacturing
/Infrastructure
Other
Total = 1.5 Million Workers in the Coverage Gap
Figure 6
Uninsured Adults in Non-Expansion States Who Would be
Eligible for Medicaid if Their States Expanded
Total = 5.2 Million Uninsured Adults
Note: Total may not sum to 100% due to rounding. The "100%-138% FPL" category presented here uses a Marketplace eligibility determination for
the lower bound (100% FPL) and a Medicaid eligibility determination for the upper bound (138% FPL) in order to appropriately isolate individuals
within the range of potential Medicaid expansions but also with sufficient resources to avoid the coverage gap.
Source: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid expansion decisions as of
January 2016 and 2015 Current Population Survey data.
Currently in the
Coverage Gap
2.9 Million (56%)
Currently Eligible
for Marketplace
1.8 Million (35%)
Currently Eligible
for Medicaid
0.5 Million (10%)
Income 100-138% FPL
Income between Medicaid
eligibility and 100% FPL
Income below
current Medicaid
eligibility


The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update
5

coverage gap and those who are instead eligible for Marketplace coverage would bring the number of uninsured
adults eligible for Medicaid to 5.2 million people. The potential scope of Medicaid varies by state (Table 2).
The ACA Medicaid expansion was designed to address the high uninsured rates among low-income adults,
providing a coverage option for people who had limited access to employer coverage and limited income to
purchase coverage on their own. However, with many states opting not to implement the Medicaid expansion,
millions of uninsured adults remain outside the reach of the ACA and continue to have limited, if any, option
for affordable health coverage: they are ineligible for publicly-financed coverage in their state, most do not have
access to employer-based coverage through a job, and all have limited income available to purchase coverage
on their own.
The majority of people in the coverage gap are in poor working families—that is, either they or a family
member is employed either part-time or full-time but still living below the poverty line. Given the
characteristics of their employment, it is likely that many will continue to lack access to coverage through their
job even with ACA provisions for employer responsibility for coverage are effective in 2016.12 Further, even if
they do receive an offer from their employer that meets ACA requirements, many will find their share of the
cost to be unaffordable. Because this population is generally exempt from the individual mandate, and because
firms will not face a penalty for these workers remaining uninsured, they will continue to fall between the
cracks in the employer-based system.
It is unlikely that people who fall into the coverage gap will be able to afford ACA coverage without financial
assistance: in 2016, the national average unsubsidized premium for a 40-year-old non-smoking individual
purchasing coverage through the Marketplace was $299 per month for a silver plan and $236 per month for a
bronze plan,13 which equates to more than half of income for those at the lower income range of people in the
gap and about a quarter of income for those at the higher income range of people in the gap. Further, people in
the coverage gap are ineligible for cost-sharing subsidies for Marketplace plans and could face additional out-
of-pocket costs up to $6,850 a year if they were to purchase single individual Marketplace coverage. Given the
limited budgets of people in the coverage gap, these costs are likely prohibitively expensive.
If they remain uninsured, adults in the coverage gap are likely to face barriers to needed health services or, if
they do require medical care, potentially serious financial consequences. Many are in fair or poor health or are
in the age range when health problems start to arise, but lack of coverage may lead them to postpone needed
care due to the cost. While the safety net of clinics and hospitals that has traditionally served the uninsured
population will continue to be an important source of care for the remaining uninsured under the ACA, this
system has been stretched in recent years due to increasing demand and limited resources.
Further, the racial and ethnic composition of the population that falls into the coverage gap indicates that state
decisions not to expand their programs disproportionately affect people of color, particularly Black Americans.
This disproportionate effect occurs because the racial and ethnic composition of states not expanding their
Medicaid programs differs from the ones that are expanding. As a result, state decisions about whether to
expand Medicaid have implications for efforts to address disparities in health coverage, access, and outcomes
among people of color. In addition, the population in the coverage gap shows that, as a result of state decisions


The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update
6

not to expand their Medicaid programs, many remaining uninsured under the ACA will reflect the legacy of the
system linking Medicaid coverage to only certain categories of people. Many people who fall outside these
categories—such as adults without dependent children—still have a need for health coverage. The ACA
Medicaid expansion was designed to end categorical eligibility for Medicaid, but in states not implementing the
expansion, the vestiges of categorical eligibility will remain.
State decisions about Medicaid expansion have implications for the potential scope of Medicaid under the ACA.
If all states expanded their Medicaid programs, eligibility for Medicaid in non-expansion states would grow
from just over half a million to 5.2 million. Though some of these people can currently purchase subsidized
coverage through the Marketplace, there are advantages and disadvantages to Medicaid and private coverage in
different states. For example, enrollees may face higher out-of-pocket costs and limited networks for
Marketplace coverage than they would for Medicaid, whereas access to specialist care may be problematic in
some state Medicaid programs. In addition, while people can enroll in Medicaid throughout the year,
Marketplace enrollment is only available during a limited open enrollment period. Medicaid is designed to
provide a safety net of coverage for low-income people, with benefits and provider networks targeted to this
population and coverage available throughout the year as people’s circumstances change. There is no deadline
for states to opt to expand Medicaid under the ACA, and debate continues in some states about whether to
expand. If more states adopt the expansion, the coverage gap will shrink and more low-income adults will gain
access to Medicaid eligibility.


Rachel Garfield is with the Kaiser Family Foundation. Anthony Damico is an independent consultant
to the Kaiser Family Foundation.


The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update
7



Alabama
139,000
46%
60%
47%
64%
Florida
567,000
57%
82%
50%
54%
Georgia
305,000
74%
72%
51%
57%
Idaho
30,000
35%
72%
47%
72%
Kansas
49,000
NA
79%
42%
77%
Maine
24,000
NA
100%
58%
88%
Mississippi
108,000
52%
77%
54%
58%
Missouri
109,000
40%
69%
60%
71%
Nebraska
27,000
NA
74%
63%
57%
North Carolina
244,000
48%
82%
53%
66%
Oklahoma
91,000
38%
73%
46%
62%
South Carolina
123,000
41%
90%
60%
51%
South Dakota
13,000
46%
80%
43%
59%
Tennessee
118,000
NA
98%
47%
NA
Texas
766,000
67%
66%
55%
69%
Utah
41,000
NA
80%
41%
65%
Virginia
131,000
52%
82%
62%
65%
Wisconsin*
0
-
-
-
-
Wyoming
11,000
NA
92%
36%
NA
NOTES: * Wisconsin is provides Medicaid eligibility to adults up to the poverty level under a Medicaid waiver. As a result,
there is no one in the coverage gap in Wisconsin.
NA: Sample size too small for reliable estimate.
SOURCE: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid
expansion decisions as of January 2016 and 2015 Current Population Survey data.





The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update
8





Alabama
241,000

NA

139,000

81,000

Florida
948,000

75,000

567,000

306,000

Georgia
521,000

47,000

305,000

169,000

Idaho
48,000

NA

30,000

16,000

Kansas
104,000

NA

49,000

46,000

Maine
44,000

NA

24,000

14,000

Mississippi
181,000

24,000

108,000

49,000

Missouri
173,000

NA

109,000

58,000

Nebraska
41,000

NA

27,000

NA

North Carolina
463,000

NA

244,000

186,000

Oklahoma
173,000

22,000

91,000

60,000

South Carolina
224,000

36,000

123,000

66,000

South Dakota
22,000

NA

13,000

NA

Tennessee
218,000

NA

118,000

68,000

Texas
1,314,000

80,000

766,000

468,000

Utah
91,000

NA

41,000

40,000

Virginia
266,000

NA

131,000

119,000

Wisconsin*
113,000

86,000

-

26,000

Wyoming
18,000

NA

11,000

6,000

NOTES: * Wisconsin is provides Medicaid eligibility to adults up to the poverty level under a Medicaid waiver. As a result,
there is no one in the coverage gap in Wisconsin. ^ The "100%-138% FPL" category presented here uses a Marketplace
eligibility determination for the lower bound (100% FPL) and a Medicaid eligibility determination for the upper bound
(138% FPL) in order to appropriately isolate individuals within the range of potential Medicaid expansions but also with
sufficient resources to avoid the coverage gap.
NA: Sample size too small for reliable estimate.
SOURCE: Kaiser Family Foundation analysis based on 2015 Medicaid eligibility levels updated to reflect state Medicaid
expansion decisions as of January 2016 and 2015 Current Population Survey data.




The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update
9

This analysis uses data from the 2015 Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC). The
CPS ASEC provides socioeconomic and demographic information for the United Sates population and specific subpopulations.
Importantly, the CPS ASEC provides detailed data on families and households, which we use to determine income for ACA
eligibility purposes.
The CPS asks respondents about coverage at the time of the interview (for the 2015 CPS, February, March, or April 2015) as well
as throughout the preceding calendar year. People who report any type of coverage throughout the preceding calendar year are
counted as “insured.” Thus, the calendar year measure of the uninsured population captures people who lacked coverage for the
entirety of 2014 (and thus were uninsured at the start of 2015). We use this measure of insurance coverage, rather than the
measure of coverage at the time of interview, because the latter lacks detail about coverage type that is used in our model. Based
on other survey data, as well as administrative data on ACA enrollment, it is likely that a small number of people included in this
analysis gained coverage in 2015.
Medicaid and Marketplaces have different rules about household composition and income for eligibility. For this analysis, we
calculate household membership and income for both Medicaid and Marketplace premium tax credits for each person
individually, using the rules for each program. For more detail on how we construct Medicaid and Marketplace households and
count income, see the detailed technical Appendix A available here.
Undocumented immigrants are ineligible for Medicaid and Marketplace coverage. Since CPS data do not directly indicate
whether an immigrant is lawfully present, we draw on the methods underlying the 2013 analysis by the State Health Access Data
Assistance Center (SHADAC) and the recommendations made by Van Hook et. al.14,15 This approach uses the Survey of Income
and Program Participation (SIPP) to develop a model that predicts immigration status; it then applies the model to CPS,
controlling to state-level estimates of total undocumented population from Department of Homeland Security. For more detail
on the immigration imputation used in this analysis, see the technical Appendix B available here.
Individuals in tax-filing units with access to an affordable offer of Employer-Sponsored Insurance are still potentially MAGI-
eligible for Medicaid coverage, but they are ineligible for advance premium tax credits in the Health Insurance Exchanges. Since
CPS data do not directly indicate whether workers have access to ESI, we draw on the methods comparable to our imputation of
authorization status and use SIPP to develop a model that predicts offer of ESI, then apply the model to CPS. For more detail on
the offer imputation used in this analysis, see the technical Appendix C available here.
As of January 2014, Medicaid financial eligibility for most nonelderly adults is based on modified adjusted gross income (MAGI).
To determine whether each individual is eligible for Medicaid, we use each state’s reported eligibility levels as of January 1, 2015,
updated to reflect state Medicaid expansion decisions as of January 2016 and 2015 Federal Poverty Levels.16 Some nonelderly
adults with incomes above MAGI levels may be eligible for Medicaid through other pathways; however, we only assess eligibility
through the MAGI pathway.17
An individual’s income is likely to fluctuate throughout the year, impacting his or her eligibility for Medicaid. Our estimates are
based on annual income and thus represent a snapshot of the number of people in the coverage gap at a given point in time. Over
the course of the year, a larger number of people are likely to move and out of the coverage gap as their income fluctuates.


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1
The 2015 federal poverty guideline for a family of three was $20,090. See: http://aspe.hhs.gov/2015-poverty-guidelines.
2
Of the states not moving forward with the expansion, only Wisconsin provides full Medicaid coverage to adults without dependent
children as of 2014. For state-by-state information on Medicaid eligibility, see The Kaiser Family Foundation State Health Facts. “Medicaid
Income Eligibility Limits for Adults as a Percent of the Federal Poverty Level.” Data Source: Based on state-reported eligibility levels as of
January 1, 2015, collected through a national survey conducted by the Kaiser Commission on Medicaid and the Uninsured with the
Georgetown University Center for Children and Families. Accessed on October 16, 2015. Available at: http://kff.org/health-reform/state-
indicator/medicaid-income-eligibility-limits-for-adults-as-a-percent-of-the-federal-poverty-level/
3
National and state-by-state estimates of the number of people in the coverage gap may change from year to year due to several factors,
including differences in the underlying data, small changes in state Medicaid eligibility, and declines in the number of uninsured people by
state as economic conditions improve.
4
Stephens, J., S. Artiga, and J. Paradise. Health Coverage and Care in the South in 2014 and Beyond. (Washington, DC: The Kaiser
Commission on Medicaid and the Uninsured), April 2014, available at: http://kff.org/report-section/health-coverage-and-care-in-the-
south-in-2014-and-beyond-health-coverage-and-care-in-the-south-today/
5
Ibid.
6
McWilliams JM, Meara E, Zaslavsky AM, Ayanian JZ. “Use of Health Services by Previously Uninsured Medicare Beneficiaries.” New England
Journal of Medicine. 2007 July 12, 357(2): 143-53.
7
For a review of findings on access to care for the uninsured, see: Kaiser Commission on Medicaid and the Uninsured. The Uninsured: A
Primer. (Washington, DC: Kaiser Family Foundation. Available at: http://kff.org/uninsured/report/the-uninsured-a-primer/
8
Ibid.
9
Sommers BD. “Insuring children or insuring families: do parental and sibling coverage lead to improved retention of children in Medicaid
and CHIP?” J Health Econ. 2006 Nov;25(6):1154-69. Epub 2006 Jun 5.
10
The "100%-138% FPL" category presented here uses a Marketplace eligibility determination for the lower bound (100% FPL) and a
Medicaid eligibility determination for the upper bound (138% FPL) in order to appropriately isolate individuals within the range of potential
Medicaid expansions but also with sufficient resources to avoid the coverage gap.
11
The vast majority of these people are eligible for tax credits to subsidize the cost of coverage in the Marketplace, though some (e.g.,
people with an offer of employer coverage) may not qualify for tax credits.
12
See http://www.kff.org/infographic/employer-responsibility-under-the-affordable-care-act/ for a review of these requirements.
13
The methods for arriving at this estimate can be found on the Kaiser Family Foundation Subsidy Calculator, (available here:
http://www.kff.org/interactive/subsidy-calculator/).
14
State Health Access Data Assistance Center. 2013. “State Estimates of the Low-income Uninsured Not Eligible for the ACA Medicaid
Expansion.” Issue Brief #35. Minneapolis, MN: University of Minnesota. Available at:
http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf404825
15
Van Hook, J., Bachmeier, J., Coffman, D., and Harel, O. 2015. “Can We Spin Straw into Gold? An Evaluation of Immigrant Legal Status
Imputation Approaches” Demography. 52(1):329-54.
16
Based on state-reported eligibility levels as of January 1, 2015. Eligibility levels are updated to reflect state implementation of the
Medicaid expansion as of September 2015 and 2015 Federal Poverty Levels, but may not reflect other eligibility policy changes since
January 2015. The Kaiser Family Foundation State Health Facts. Data Source: Kaiser Commission on Medicaid and the Uninsured with the
Georgetown University Center for Children and Families: Modern Era Medicaid: Findings from a 50-State Survey of Eligibility, Enrollment,
Renewal, and Cost-Sharing Policies in Medicaid and CHIP as of January 2015, Kaiser Family Foundation, January 20, 2015.
17
Non-MAGI pathways for nonelderly adults include disability-related pathways, such as SSI beneficiary; Qualified Severely Impaired
Individuals; Working Disabled; and Medically Needy. We are unable to assess disability status in the CPS sufficiently to model eligibility
under these pathways. However, previous research indicates high current participation rates among individuals with disabilities (largely
due to the automatic link between SSI and Medicaid in most states, see Kenney GM, V Lynch, J Haley, and M Huntress. “Variation in
Medicaid Eligibility and Participation among Adults: Implications for the Affordable Care Act.” Inquiry. 49:231-53 (Fall 2012)), indicating
that there may be a small number of eligible uninsured individuals in this group. Further, many of these pathways (with the exception of
SSI, which automatically links an individual to Medicaid in most states) are optional for states, and eligibility in states not implementing
the ACA expansion is limited. For example, the median income eligibility level for coverage through the Medically Needy pathway is 15% of
poverty in states that are not expanding Medicaid, and most states not expanding Medicaid do not provide coverage above SSI levels for
individuals with disabilities. (See: O’Mally-Watts, M and K Young. The Medicaid Medically Needy Program: Spending and Enrollment
Update. (Washington, DC: Kaiser Family Foundation), December 2012. Available at: http://www.kff.org/medicaid/issue-brief/the-
medicaid-medically-needy-program-spending-and/. And Kaiser Commission on Medicaid and the Uninsured, “Medicaid Financial Eligibility:
Primary Pathways for the Elderly and People with Disabilities,” February 2010. Available at: http://www.kff.org/medicaid/issue-
brief/medicaid-financial-eligibility-primary-pathways-for-the-elderly-and-people-with-disabilities/.