It is not widely enough discussed that it is possible to have an income below the federal poverty line and still not qualify for Medicaid. It is a legacy of the peculiarly federal-state shared authority for Medicaid that we have -- to repeat the truism -- fifty different Medicaids.
But what really ought to impress is just how different those fifty different Medicaids can be. New Jersey, for instance, will provide Medicaid eligibility for parents with incomes at the federal poverty level (about $18,500 for a family of three in 2011) while Missouri will only reach parents with incomes at about 18% of the FPL. (MO actually bases its eligibility on 1986 AFDC eligibility guidelines but I standardize the numbers to the FPL for comparison purposes, though the lack of a standardized eligibility measure should be telling in and of itself.)
After the Supreme Court's ruling on the Affordable Care Act, we may not see the standarization of Medicaid eligibility the statute contemplated. This is more than an interesting historical disquisition if states choose not to opt-in to the ACA's Medicaid expansion.
In fact, disparate treatment of low income Americans could only be increased by less than complete opt-in to Medicaid expansion. This disparate treatment, long the hallmark of Medicaid, may actually penetrate public consciousness in metropolitan areas, like Kansas City, where ACA expanded Medicaid may be available in one part of the city but not in the other. And this makes me curious about interstate migration and housing patterns as they relate to health insurance. We should all be curious.