Health Center State Policy

New Report Highlights Significant Number of Health Center Patients Remain Uninsured in States that Opt Out of Medicaid Expansion

By Heidi Emerson

There are significant consequences for health centers in the 25 states that have opted out of the Medicaid expansion provisions in the Affordable Care Act which would allow Medicaid to cover all nonelderly adults with incomes up to 138% of the federal poverty level (FPL). Health centers in these 25 states serve approximately 3.1 million uninsured patients, and while 1.2 million will be eligible for Medicaid, CHIP or Marketplace subsidies, approximately 1 million of those patients that could have been eligible for coverage with expansion will remain uninsured, according to a new report released by George Washington University and the Geiger Gibson RCHN Community Health Foundation.  Since eligibility for Marketplace subsidies generally apply to families who exceed 100%FPL, the poorest uninsured adults who do not qualify for the state’s current Medicaid program, will remain uninsured.  A state-by-state analysis of 2011 UDS data shows that 72% of the remaining uninsured will be in southern states, which includes Texas, North Carolina, and Florida.

The full report can be viewed here: Assessing the Potential Impact of the Affordable Care Act on Uninsured Community Health Center Patients: A Nationwide and State-by-State Analysis, by Peter Shin, PhD, MPH, Jessica Sharac, MSc, MPH, and Sara Rosenbaum, JD.  RCHN Foundation hosted a webinar on Nov. 7th with the lead authors Peter Shin and Sara Rosenbaum and health center CEO Rachel Gonzales-Hanson presenting the findings.

Looking at the distribution of uninsured patients at health centers by income based on general Medicaid assistance categories, it is estimated that there are approximately 5 million patients at health centers who are uninsured and would qualify for Medicaid assistance up to 138% FPL.  Approximately 2.8 million of these patients will be eligible for coverage through Medicaid or eligible for Marketplace subsidies in the states that expand Medicaid. In Ohio, where Medicaid expansion was recently approved, potentially 81% of uninsured health center patients (131,580) may gain coverage, as compared to 42% of patients (68,226) if they had opted out.

The authors noted that while health centers will benefit from expanded coverage for the uninsured at their health centers and in the community, there are still challenges ahead. Looking at the effect of Massachusetts’s 2006 health reform on health centers, while the proportion of uninsured patients at health centers declined and then stood still at 21.3% in 2011, the number of uninsured patients actually increased by 6% during the same period of time.  This indicates the need for health centers to continue growing their capacity to serve the community. However, health centers in opt out states will fall further behind as they will not receive the funds needed to hire additional providers and to serve their patients.