Medicaid Expansion in New Jersey

A key feature of the Affordable Care Act (ACA), the loosening of Medicaid eligibility requirements, is aimed at making coverage available to the working poor whose wages are near the federal poverty line. Upon a finding of the U.S. Supreme Court that state governments had a right to opt out of Medicaid expansion, questions arose as to how the weakening of this key provision would impact the effectiveness of the ACA as a whole. Ultimately, 26 states — including New Jersey — opted to expand Medicaid, potentially bringing about an influx of new patients in those states.

The new income thresholds that apply under Medicaid expansion mean that free health coverage may now be available to people who previously would not have qualified, especially single adults without dependents:

  • Single individuals earning less than $15,516 per year
  • A family of two earning less than $20,916 per year
  • A family of three earning less than $26,316 per year
  • A family of four earning less than $31,716 per year

Health care providers can view the impact of this expansion in one of two ways. On the one hand, it means more patients with the ability to pay as well as fewer out-of-pocket patients and the difficulties they can generate. On the other hand, the Medicaid reimbursement rate is typically much lower than what private insurance or a self-pay patient would pay. Therefore, while doctors may soon be seeing more patients, their revenues may not rise proportionally.

Every practice in New Jersey and other expansion states ultimately needs to examine their financial position to determine whether it makes sense to take on Medicaid patients. Consulting with a respected health care law firm in New Jersey can help medical practitioners determine how these new laws could affect them.

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Posted in: Reimbursement