For Mississippians After Implementation of the ACA
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As of January 2014, individuals in the United States are required to carry health insurance as a mandate under the Affordable Care Act (ACA), or they may be subject to a financial penalty. This brief describes coverage options for the uninsured in Mississippi and examines alternative coverage models being tested in other states.
The Affordable Care Act (ACA) includes two primary components aimed at providing financial assistance for low-income uninsured persons to obtain coverage: Medicaid expansion and subsidized coverage through Health Insurance Marketplaces (formerly known as “Exchanges”). The ACA’s expansion of Medicaid initially eliminated categorical requirements (e.g. disability, age, or pregnancy), and allowed for coverage for all individuals based solely on financial status at or below 133 percent of the federal poverty level (FPL). The June 2012 U.S. Supreme Court decision that upheld the individual mandate allows for states to opt out of the Medicaid expansion. Mississippi is among the 25 states not moving forward with
expanding Medicaid in 2014.
133% OR 138%?
Federal law provides for the expansion of Medicaid to all individuals whose
Modified Adjusted Gross Income (MAGI) is at or below 133% FPL.
Because the law also includes a 5% “income disregard” for Medicaid
eligibility, the effective limit is 138% FPL. This report will use 133% or 138%,
depending on the context.
133%: Used to describe eligibility level
138%: Used to calculate the eligible population
Health Insurance Marketplaces are intended to provide access to private health insurance plans. Individuals whose incomes are between 100 percent and 400 percent FPL may qualify for federally subsidized coverage, based on a sliding scale, which will only be offered through the Marketplace. Marketplaces can be either state-based, federally operated, or a combination. Mississippi is one of 27
states which have a federally facilitated Marketplace in 2014.
Annual Incomes Associated with 2014 Federal Poverty Percentages
| % Federal Poverty Level | Single | Family of Four |
|---|---|---|
| 100% | $11,670 | $23,850 |
| 138% | $16,105 | $32,913 |
| 400% | $46,680 | $95,400 |
Because low-income children, pregnant women, the disabled and the elderly currently may qualify for Medicaid or Medicare, they are less likely to be uninsured. Therefore, the target population for federally subsidized coverage under the ACA consists primarily of adults 19-64 years of age. Figure 1 illustrates the sources of health coverage for this group in Mississippi.
Mississippi’s Uninsured: A Closer Look
Employment and Health Coverage
If an individual has access to employer-based health coverage (through their own employer or a spouse’s employer) that is deemed “affordable” and of “minimal value,” he or she will not be eligible for subsidies, regardless of income. The determination of whether the premium is affordable is based on the cost of
employee-only coverage compared to the household income. Consequently, a policy may be classified as “affordable” even though the family premium may be more than the family can pay, resulting in some members remaining uninsured. The family members may be exempt from individual mandate penalties, however, because a different definition of affordability applies to penalties. Figure 3 illustrates an example of this situation for a family of four with an annual income of $47,000 (200% FPL).
IMPACT OF EMPLOYER COVERAGE
If an individual has access to employer-based health coverage that is deemed “affordable” and
of “minimal value,” he or she will not be eligible for subsidies, regardless of income.AFFORDABLE: Employee contribution for employee-only coverage
does not exceed 9.5% of annual incomeMINIMUM VALUE: Pays for at least 60% of the actuarial value
of services included in the plan
| Employee Share of Monthly Premium | Premium as % of Income | Deemed Affordable? | |
|---|---|---|---|
| Single Coverage | $0 | 0% | Yes |
| Family Coverage | $593 | 15% | Yes* *Because “affordable” definition is based on cost of single coverage |
Half (51%) of Mississippi’s non-elderly adults have private, employment-based insurance coverage, a significantly (p<.01) lower rate of private health insurance coverage than the national average, which is 58 percent (2012). Mississippians who work for small employers (fewer than 50 employees) are more at risk to remain uninsured, as only 29 percent of small employers in the state offered health insurance in 2012.
Figure 4. Leading Occupations in Mississippi with Uninsured Workers at or Below 138% FPL
| Cashiers | 14,656 |
| Cooks | 9,907 |
| Waiters & Waitresses | 8,002 |
| Medical Aides | 6,668 |
| Maids & Housekeepers | 6,430 |
| Truck & Other Drivers (Sales) | 6,077 |
| Janitors & Cleaners | 4,982 |
| Construction Laborers | 4,500 |
| Retail Salespersons | 3,340 |
| Assemblers & Fabricators | 3,216 |
| Stock Clerks & Order Fillers | 3,035 |
| Laborers & Movers | 2,918 |
| Personal Care Aides | 2,682 |
| Carpenters | 2,488 |
| Grounds Maintenance Workers | 2,380 |
| Agriculture Workers | 2,362 |
| Other Production Workers | 2,326 |
| Painters & Maintenance | 2,142 |
| Retail Sales Supervisors | 2,058 |
| Childcare Workers | 1,780 |
Selected Alternative Models
Some states not opting to expand Medicaid as outlined in the ACA are testing alternative models for expanding coverage. A few examples are listed below:
Wisconsin is not currently pursuing Medicaid expansion and will participate in the federally facilitated Marketplace. The state has proposed to decrease Medicaid eligibility for all types of beneficiaries from 200 percent to 100 percent FPL, and shift the uninsured over 100 percent of poverty to the Marketplace for coverage subsidized by the federal government. The money saved by removing this population from the Medicaid program would be spent to cover low-income persons, including approximately 82,000 childless adults up to 100 percent FPL.
Oklahoma is participating in the federally facilitated Marketplace, and did not elect to expand Medicaid under the ACA. In September 2013, the state was issued an 1115 Medicaid waiver which modifies eligibility for “Insure Oklahoma,” a program in place since 2005, to include the population between Medicaid and the Marketplace subsidies. Previously, Insure Oklahoma served as a Medicaid premium assistance program for 30,000 low income workers, providing individual policies and coverage purchased through small employers.
Arkansas had an 1115 Medicaid waiver approved in September 2013 to allow the state to use Medicaid funds to purchase coverage in the private market through the state Marketplace for a newly eligible category of recipients, including adults with incomes under 138 percent FPL. The demonstration, which has been approved for three years, will cover an estimated 225,000 newly eligible individuals.
Additional Information
For more detailed information on health insurance coverage in Mississippi, Health Insurance Exchanges, or Medicaid Expansion, please see the Center’s issue briefs, fact sheet, and chart books on these topics.
- Medicaid Expansion | November 2012
- Building Mississippi’s Health Insurance Exchange | Winter 2012
- Uninsured Adults
References
- Kaiser Family Foundation. (October 2013). States decisions about the Medicaid expansion as of October 22, 2013. Based on data from the Centers for Medicare and Medicaid Services. Retrieved from: http://medicaid.gov/AffordableCareAct/Medicaid-Moving-Forward-2014/Medicaid-and-CHIP-Eligibility-Levels/medicaid-chip-eligibility-levels.html
- Kaiser Family Foundation. (2013). State decisions for creating health insurance marketplaces. Retrieved from: http://kff.org/health-reform/state-indicator/health-insurance-exchanges/
- Center for Mississippi Health Policy. (January 2014). Health coverage for Mississippi adults 19-64 years of age: An analysis of 2012 American Communities Survey and 2012 Medical Expenditures Panel Survey Data. Available at: http://www.mshealthpolicy.com/health-insurance-coverage-in-mississippi/
- 45 CFR 155.605(g)(5)
- Wisconsin Department of Health Services. (November 2013). BaderCare Plus Demonstration Project Waiver Request. Retrieved from: http://www.dhs.wisconsin.gov/aboutdhs/initiatives/budget/initiatives/er/index.htm
- Centers for Medicare and Medicaid Services. (January 2014). Waivers. Retrieved from: http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers.html
- Kaiser Family Foundation. (December 2013). Medicaid expansion through premium assistance: Arkansas, Iowa, and Pennsylvania’s proposals compared. Retrieved from: http://kff.org/health-reform/fact-sheet/medicaid-expansion-through-premium-assistance-arkansas-and-iowas-section-1115-demonstrationwaiver-applications-compared/
