The Patient Protection and Affordable Care Act (“Obamacare”) is one of the most significant and controversial pieces of legislation to have been passed for many years. Despite numerous legal challenges, the U.S. Supreme Court has generally ruled that the legislation is constitutional. However, in a recent case, the Court held that states may opt out of the Medicaid expansion.

What is covered in the Medicaid expansion?

Medicaid has traditionally involved state receipt of federal government funds to provide health care coverage to pregnant women, children, families in need, the elderly and blind and disabled individuals. The new Medicare provisions aim to expand the scope of the program and provide coverage to more people.

One way that the Medicaid expansion increases coverage is by changing the eligible income levels. As of January 1, 2014, all families and individuals who earn up to 133 percent of the federal poverty level would qualify. Based on current figures, you could receive Medicaid benefits if you are an individual and have an annual income of up to $15,282. For a household of four, the threshold is $31,322.

Why are some states opting out?

The federal government has promised to fund 100 percent of the costs of expansion for the first three years of the program and then gradually reduce this subsidy to 90 percent by the year 2020. Despite these promised federal funds, a number of states are opting out of the expansion, citing concerns that they will eventually have to make up for any federal government shortfall out of their own coffers.

In a statement issued on June 28, 2012, New York Governor Andrew M. Cuomo indicated the state’s intention to participate in the expansion.

How will my Medicaid entitlement be affected?

The rules for Medicaid eligibility are complex, and whether you are eligible or not depends on a number of factors, including your age, your resources, whether you have a disability and your income level. For some New Yorkers, these new maximum income levels are higher than current thresholds meaning that more people would be entitled to Medicaid.

If your application for Medicaid has been rejected in the past, you may find it worth your while to reapply as you may become eligible when the new rules come into effect. Speak to an experienced Staten Island Medicaid planning attorney for advice.

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