Medicaid

Recently, a lot of information has circulated about changes to the Medicaid service, creating uncertainty and, for many, understandable fear. However, it is crucial to understand the details to avoid unnecessary alarmism and, most importantly, to prepare adequately. Here we break down what you need to know.

Who will be the most affected by the new requirements?

It is true that it is estimated that between 11 to 17 million people could be impacted in the next decade. But hold on! It is essential to understand that the affected group is very specific:

• Adults without children, aged between 19 and 64 years.

For this particular group, a minimum of 80 hours per month of work, volunteering, or study will be required. The idea behind this, as stated in the video, is to create an "order" in the system.

There is time to prepare! The gradual implementation until 2027

Although the federal law has already gone into effect, states have an extended deadline until 2027 to implement these measures. This means that those affected have a considerable amount of time to organize their documentation, seek job or volunteer opportunities, or enroll in study programs. Additionally, it is important to highlight that the exact application of the law may vary from state to state. Some states, depending on their circumstances, could even cover 100% of the benefits, which would exempt certain individuals from these new requirements.

Who will NOT be affected? Exceptions are key!

One of the most important pieces of information to avoid panic is knowing who is NOT subject to these new requirements. These measures do NOT APPLY to:

• People with disabilities.
• Pregnant women.
• Children and adolescents.
• People who currently qualify for food stamps (SNAP).
• People over 65 years old.
• (It has also been confirmed in recent news that parents of children under 13 years old and medically fragile individuals are exempt.)

These essential groups of the population will not have to demonstrate hours of work, community service, or study to maintain their Medicaid benefits.

New costs: What is the $35 copayment about?

Another point of discussion is the associated costs. Starting in 2027, Medicare (and in certain cases Medicaid, as mentioned in the video for the income range) will expand its benefits for individuals earning between $15,000 and $21,000. This specific group will have to pay a copayment of $35 to access more expensive services such as:

• Hospitalization.
• Dialysis treatments.
• Hospital emergencies.

However, it is essential to clarify that this copayment DOES NOT APPLY to primary and preventive medical care, which includes:

• Consultations with the primary care physician.
• Annual check-ups.
• Preventive medicine in general.

Beyond the Immediate News: A Look at the Medicaid Landscape

The recent discussions about Medicaid go beyond work requirements. Proposals are being debated that could include significant cuts to federal Medicaid funding, which in turn could pressure states to reduce coverage or benefits. This could particularly impact rural hospitals, which would see an increase in uncompensated costs. The implementation of the new requirements also presents challenges, as more frequent recertification processes could lead to eligible individuals losing their coverage simply due to "paperwork" issues. A loss of coverage for millions of people has already been observed since 2023. Additionally, efforts to combat fraud within the system and litigation regarding the use of immigration data in relation to Medicaid continue.

Although the Medicaid landscape is constantly evolving and there are significant changes on the horizon, it is vital not to fall into misinformation. The new restrictions target a specific demographic group, and there are broad exemptions. There is time to prepare, and states will play a crucial role in how these measures are implemented. Stay informed through reliable sources and your state agencies to understand how these changes could affect you or your loved ones. Information is power!