The Republican’s new federal health care bill — the American Health Care Act — would make substantial changes to Medicaid.
What is Medicaid and how does it work in Colorado? Here are nine questions and answers to get you up to speed.
1. So, let’s start simple. What is Medicaid?
Medicaid is the government’s health care program for low-income kids and adults. People on Medicaid typically don’t have to pay for medical services, though there may be co-pays for some things. In general, you have to make tiny amounts of money to qualify for Medicaid.
2. What are the income limits to qualify for Medicaid?
Up until the Affordable Care Act — that is, Obamacare — took effect, adults had to earn at or below the federal poverty line to be eligible for Medicaid in Colorado. For a single adult with no dependent kids, that means making below $12,060 in 2017. Children and pregnant women can qualify at higher household incomes, and Obamacare raised the eligibility level for states that adopted “Medicaid expansion.” But there are no Rockefellers on Medicaid.
3. What is the Medicaid expansion?
Hold on, we’ll get there.
4. I’ve heard of Health First Colorado. How is that different?
It’s not. They’re the same thing, but each state administers its own Medicaid program. In Colorado, that program is called Health First Colorado because there is nothing that the American health system can’t make more confusing. Health First Colorado has an entire FAQ page about its own name.
5. If the state administers it, how much does Medicaid cost Colorado?
The state department that oversees Medicaid is the Department of Health Care Policy and Financing, or HCPF. (The acronym is pronounced “HIC-puff,” calling to mind a drunk dragon.) It has an operating budget this year north of $9 billion. That is a third of the state’s total operating budget, but most of that money comes from the federal government. About $3.5 billion comes from state funds.
6. $9 billion? How many people are on Medicaid in Colorado?
Around 1.4 million. Given that there’s roughly 5.5 million people total in Colorado, that means Medicaid insures about one out of every four Coloradans. While it was once basically equal in enrollment to Medicare — the government’s health insurance for the elderly — Medicaid enrollment now dwarfs that of Medicare in the state. It’s also worth noting that, to be eligible for Medicaid, a person has to be a U.S. citizen or eligible legal immigrant.
7. Why did Medicaid grow so fast in Colorado?
Remember Medicaid expansion? A decade ago in Colorado, you had to be really poor to qualify for Medicaid — making less than two-thirds of the federal poverty level. In 2009, Colorado lawmakers voted to open Medicaid up to all people below the poverty line.
Then Obamacare came along, and most Colorado lawmakers embraced it by taking up the law’s offer to expand Medicaid further — to 133 percent of the federal poverty level, or about $15,800 a year in income for a sinle person. Around 400,000 people in Colorado signed up for Medicaid under Obamacare’s expanded eligibility, far more than projected. That chunk of folks — those between 100 and 133 percent of the federal poverty level — are now known as the “expansion population.”
8. And what did the Obamacare Medicaid expansion cost the state?
Up to now, not a lot as far as big-picture health policy is concerned. Normally, Colorado and the feds split the cost of Medicaid 50/50, though the federal government pays more for kids. For the expansion population, though, the feds paid everything for the first few years.
Next fiscal year (so, starting this July), the state is expected to pay $120.7 million for the expansion, which Marc Williams, HCPF’s spokesman, said will come from the Hospital Provider Fee. (Don’t even ask about the Hospital Provider Fee.) That will rise to $222 million in 2020, when the state and the feds settle into a 90/10 split, according to the Colorado Health Institute.
9. How does the GOP’s health plan change things?
In a bunch of really consequential ways. But, now that you’ve graduated from Medicaid 101, this is the subject for our next Q&A, which you can read here.