What do programs like Health First Colorado, New Jersey FamilyCare, Iowa Health Link and the Healthy Michigan Plan have in common? They are all Medicaid expansion programs, but they also all list the eligibility cap for their programs at 133 percent of the Federal Poverty Level (FPL), but is that the final number? Read on to find out when 133 percent isn’t always 133 percent.
The ACA and Expanded Medicaid
In 2014 the Affordable Care Act (ACA) provided states the authority to expand Medicaid eligibility to individuals under the age of 65 in families with incomes under 133 percent of the FPL. This number seemed pretty cut and dry, but wording within the ACA called for a modified adjusted gross income (MAGI) that is based on the adjusted gross income as defined as the Internal Revenue Code that equates to 5 percent.
What Does Expanded Medicaid Mean?
When states that participate in Medicaid expansion, some will list coverage for individuals up to 133 percent of the FPL, others go straight to 138 percent. While these states may appear to have different levels of eligibility, in effect all are at 138 percent, even though the statutory base is 133 percent.
What Expanded Medicaid Looks Like in 2025
When calculating incomes for expanded Medicaid eligibility, there can be two numbers shown. If they show the income for a single individual at 133 percent, you would see that income has to be at or under $1,735 per month. But accounting for the 5 percent disregard, the effective cap would be $1,800 per month, which is slightly higher. While this amount doesn’t greatly change things, it does effect the cap.
The Bottom Line
When it comes to expanded Medicaid or the various state program names, 133 percent may be the number listed, but with the 5 percent MAGI disregard, it raises the eligibility ceiling to 138 percent, which is slightly above what may be listed.
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