Helping Marginalized Populations: The Top 5 Things You Should Know about the Medicaid Expansion

Image courtesy of California Medical Association.

Unlike gender rights and GENDA, in terms of health care coverage, New York stands poised to lead the country by delivering a wider array of health care services through the Medicaid Expansion as outlined in the Affordable Care Act. Medicaid, a federal program whose benefits are distributed by the states, is one of the major sources of health care coverage for low-income people and those living with HIV/AIDS.

Traditionally, however, eligibility for Medicaid was very limited, precariously pivoting on age requirements, income levels, and proof of a disability, e.g. an AIDS diagnosis and/or HIV and an opportunistic infection. Populations that were already living on the margins -- particularly people of color, homeless people, and LGBT folks -- who have higher rates of chronic illnesses and face the most barriers to accessible and affordable health care, were frequently denied coverage due to these requirements, further deepening the cycles of racial and sexual inequities, health disparities, and poverty.

But this all may change within the next few years. The Medicaid Expansion plan has enormous potential to help New York state residents who are homeless and/or living with HIV/AIDS, as well as help reduce the number of new infections nationally, as strategized in the National HIV/AIDS Prevention Plan.

But unless you really enjoy reading dense policy reports or have the time to read a 50-page report, you might miss these important provisions for populations that have largely been disregarded under previous federal and state programs.

So here are the top 5 things you should know about New York's plan and the Medicaid Expansion plan under the Affordable Care Act.

1. The Medicaid Expansion lowers the income threshold of eligibility for coverage by nearly $5,000, allowing all individuals with an income below 133% of the Federal poverty line to be covered ($14,400 for an individual and $29,300 for a family of 4). Put simply, 32 million lower-income people will now have health care coverage, and 75% of the newly covered are people of color. Additionally, insurance companies can no longer impose those nasty and often debilitating caps on lifetime coverage, meaning you cannot max out your benefits, EVER. Bravo, bravo.
2. Previously, people with HIV had to wait for the onset of an opportunistic infection to be considered "disabled" and thus eligible for Medicaid. Under this extended eligibility, however, people who are HIV-positive and meet other (income) requirements are immediately eligible, keeping people healthier and reducing the number of AIDS infections per year. What's more, folks who receive their meds through the Ryan White ADAP program will likely be covered under the new expanded Medicaid, greatly lowering their out of pocket costs.
3. States will be allowed more flexibility in serving the homeless by leveraging local services, such as health homes, with chronic care management and preventative services. This move echoes what we have been saying for years, housing IS health care: you give people with HIV/AIDS stable housing, and their ability to take their meds increases and they become less likely to pass the disease onto their loved ones.
4. The New York state plan specifically calls for Medicaid to fund harm reduction services and syringe exchange programs and prescriptions. Specifically, the plan outlines that doctors be given the power to prescribe clean syringes to prevent disease transmission and the Department of Health's AIDS Institute Syringe Exchange programs be reimbursed through Medicaid. While New York has been a sheer disappointment in gender rights, this is a very positive step forward to realizing the power behind harm reduction programs and other states following suit.
5. Finally, know that the Medicaid Expansion is optional for states. That's right, even with the enormous potential to extend coverage to millions and millions of vulnerable people; lower the rates of HIV/AIDS across the country; help the homeless; help the disenfranchised; provide preventative services at little to-no-cost (think HIV testing, prostate exams, breast exams, pap smears, etc.); provide little-to-no-cost mental health care; states are not required to alter their Medicaid coverage.

In fact, a number of states have shamefully already decided to opt out of expanding their Medicaid coverage, including Texas and Florida, two states that have some of the highest HIV/AIDS rates in the country. (The others states claiming to opt out include South Carolina, Wisconsin, and Louisiana). Moreover, Texas has the highest rate of uninsured residents in the nation, with over 25% lacking health insurance, or 6.2 million people, yet this guy thinks he is doing his state a favor.

Sadly, the move to transform the state of health care delivery and access in this country will have to be done piece by piece, state by state, with California and New York leading the way.

Stay tuned for more updates on New York's Medicaid Expansion and its implementation.