C-TAC News

The Blog to Transform Advanced Care

Advancing Care through Innovation, Observation and Collaboration.

How a New Federal Medicaid Program May Expand Access to Care for Serious Illness

Our team of policy experts is closely monitoring new developments of the Senate reconciliation bill under consideration. As pieces of legislation make their way through Congress, we have identified multiple components that align with our 2021 Policy Agenda. Most recently, budget reconciliation set to be considered in the House Energy and Commerce committee seeks to provide access to health coverage for over 2 million uninsured Americans who fall into a gap in access to affordable health plans.

This coverage gap is created by income limits for Medicaid eligibility and marketplace tax credits in states that have not expanded Medicaid to offer the coverage provided by the Affordable Care Act (ACA). As a result, low-income individuals, even those with incomes below the federal poverty line, may not be eligible for Medicaid, and are left to seek coverage in a marketplace meant for individuals earning at least 138% of the federal poverty line, pay for potentially costly coverage offered by employers, or go without insurance. This places more people at risk of serious illness derived from lacking preventive care, missed screenings, and lack of treatment adherence. Additionally, existing policies disproportionately impact Black and Latinx individuals, who represent more than half of those who fall into the coverage gap. The proposed legislation aligns with C-TAC’s commitment to advancing health equity and increasing access to critical treatments and services for those living with serious illness.

The legislation under consideration aims to close the coverage gap by implementing immediate and long-term solutions for low-income individuals who find themselves unable to access coverage. The bill would begin implementation in January 2022 by expanding eligibility for premium tax credits in ACA marketplaces to include low-income individuals in non-expansion states who would be eligible for Medicaid under ACA expansion guidelines. The Secretary of HHS would have until January 2025 to contract Medicaid Managed Care programs to administer a federal Medicaid program that aligns with ACA-derived Medicaid expansion guidelines, and would cover those receiving premium tax credits under the first component of the bill. The federal Medicaid program would permanently close the coverage gap while maintaining incentives for state expansion of Medicaid. Under this program, millions of low-income individuals would gain access to coverage for mandatory health benefits, including; inpatient hospital services, nursing home services, home health, medical transportation, and more. 

Low-income non-elderly Medicaid beneficiaries have a high prevalence of chronic health conditions and evidence shows that Medicaid coverage creates low-barrier access to needed care. For those who are uninsured, barriers in access to affordable care results in lower utilization of basic services and delayed care for serious illness. The short- and long-term solutions proposed in this component of the reconciliation bill will help resolve financial barriers to care that perpetuate health disparities in low-income communities, particularly Communities of Color, and advance equity throughout health systems treating people with serious illness.

Our team of policy experts is closely monitoring the progression of legislation pertaining to Senate reconciliation. As we seek to build an equitable and quality healthcare system that works for all people living with serious illness, our coalition is encouraged by these transformative policy solutions progressing through Congress as a part of the Build Back Better plan.

For more information on C-TAC’s policy and advocacy work, please visit our website here.

Leave a Comment