Annals of Health Law - Vol 23 Issue 1

Vol 23, 2014 Annals of Health Law 51
THE ACA AND PEOPLE LIVING WITH HIV/AIDS
income requirement for either ( 1) Medicaid or ( 2) federal subsidies.186

However, because states are free to opt out of the Medicaid expansion, childless adults who earn less than the FPL will not be eligible for either Medicaid or federal subsidies.187 Some low-income parents and other adults who typically meet Medicaid’s non-income-based requirements in states that limit Medicaid eligibility to people earning less than the FPL will fall into the same gap.188 In these states, if a low-income parent earns less than the FPL but too much for Medicaid, that parent will also be ineligible for both Medicaid and subsidies.189 Currently, thirty-three states have such Medicaid eligibility requirements, and seven limit Medicaid eligibility to people earning less than half of the FPL.190 As of 2010, sixteen million people would have fallen into this gap.191 This is a harmful side effect of the Court’s ruling in National Federation that has thus far gone unaddressed.

2. The Medicaid Access Crisis
The Medicaid program itself contains significant access issues that
PPACA does not address. Health care access for Medicaid enrollees is
dependent on the availability of doctors willing to treat them.192 And
although the Social Security Act explicitly requires that states ensure that
services are available to program participants,193 more and more medical
service providers are eliminating their Medicaid practice or lowering the
number of participants they treat.194 Physicians’ lack of involvement in the
program is a result of shrinking reimbursement rates from the states, many
of which have turned to cutting the amount physicians have to be paid for
treating Medicaid beneficiaries in the face of serious budgetary shortages.195

186. See Editorial, A Gap in Health Coverage, N. Y. TIMES, July 5, 2012, at A18.

187. Kaiser Family Found., How will the Medicaid Expansion for Adults Impact Eligibility and Coverage? 1 (2012), http://kaiserfamilyfoundation.files.wordpress.com/2013 /01/8338.pdf.

188. Id.

189. Id.

190. Id.

191. Id.

192. See Brietta R. Clark, Medicaid Access, Rate Setting and Payment Suits: How the Obama Administration is Undermining its Own Health Reform Goals, 55 HOW. L.J. 771, 773 (2012); see also ANDREW B. BINDMAN ET AL., PHYSICIAN PARTICIPATION IN MEDI-CAL, 2008 2 (2010), available at http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/ P/PDF%20PhysicianParticipationMediCal2008.pdf.