Starting Tuesday, more low-income Marylanders will be eligible for Medicaid, the joint federal-state health insurance program for the poor and disabled.
That's because Maryland chose to expand the state's Medicaid program, granting more individuals the eligibility to enroll when the state-based insurance marketplace launches Tuesday. It was a health-care reform option not all states decided to implement, leaving gaping holes in coverage for some low-income individuals in those states, according to the Kaiser Family Foundation, a nonprofit that analyzes major U.S. health-care issues.
Maryland's decision wasn't without careful analysis and forethought, Charles Milligan Jr., Maryland Department of Health and Mental Hygiene deputy secretary of health-care financing, wrote in a healthaffairs.org blog post explaining the state's decision.
"Medicaid expansion in the [Affordable Care Act] is a hotly contested issue," Milligan wrote.
"Maryland crunched the numbers and found that, whether judged on economic grounds, personal costs, or in human terms, the conclusion is clear - implementation of the Medicaid expansion is the best choice for Maryland, our citizens, our economy, and our future."
President Barack Obama's Affordable Care Act originally required all states to expand Medicaid to those at or below 138 percent of the federal poverty level. This, for example, equates to a $15,856 annual income for a household of one or about $32,500 annually for a family of four, according to Maryland Health Connection's website.
On June 28, 2012, the Supreme Court handed down a landmark decision upholding the major provisions of the Affordable Care Act, also known as Obamacare. However, the court determined it was unconstitutional for the federal government to require states to expand Medicaid services.
And, thus, the decision was left up to the states.
As of Sept. 16, there will be 26 states, including Washington, D.C., moving forward to expand Medicaid, 22 that are not implementing the expansion and three are still debating, according to a Kaiser Family Foundation.
Maryland chose to expand the state's Medicaid program. This allows those up to 138 percent of the federal poverty line to qualify. Previously, Medicaid had been given to state residents up to 116 percent of this line, according to Maryland Health Connection.
In Maryland, expanding Medicaid is estimated to insure about 143,000 more residents in the benefits program by 2020, according to a 2012 analysis by The Hilltop Institute at the University of Maryland, Baltimore County, a nonpartisan health research organization with an expertise in Medicaid. A total of about 800,000 Maryland residents, or 14 percent of the population, are currently uninsured.
An estimated 8,022 Carroll residents are uninsured, which equates to about 5.6 percent of the county's population. About 40 percent of those will be eligible to enroll in Medicaid, according to the Centers for Medicare and Medicaid Services and the Office of the Assistant Secretary for Planning and Evaluation.
Those enrolled in the Primary Adult Care (PAC) program - which provided health service to those whose annual income was limited - will automatically be transferred to receive full Medicaid benefits on Jan. 1. They'll be notified of this change during the fall, according to Maryland Health Connection.
Bettering the health of Maryland residents was one main reason for expanding Medicaid, Milligan wrote in his blog post, citing a New England Journal of Medicine report stating that expanding Medicaid coverage for low-income adults could reduce mortality by 6.1 percent.
"Saving lives is a compelling reason to move forward," Milligan wrote. "Our Gov. Martin O'Malley and Lt. Gov. Anthony Brown have placed a high priority on expanding coverage to hundreds of thousands of Maryland families and children since taking office."
It also helps the Maryland economy and state budget, adding $2.5 billion in federal funds by the end of 2020, according to the Hilltop Institute.
The Kaiser Family Foundation estimates expanding Medicaid will likely be positive for those states' economies, possibly resulting in more jobs and increased revenue.
Those living in Maryland have an advantage over residents of states that decided not to expand Medicaid, according to Karoline Mortensen, a University of Maryland, College Park, health services administration assistant professor who studies the impact of the Affordable Care Act on Medicaid enrollees.
That's because there could be a gap in coverage for low-income individuals in those areas. Most adults without children won't be covered. Some parents with incomes slightly above Medicaid eligibility levels in their state also may not receive subsidies to purchase health coverage through the exchange, according to the Kaiser Family Foundation's report evaluating the Affordable Care Act Medicaid expansion for states.
"This could leave individuals with higher incomes access to health coverage options while leaving those with lower incomes few or no options for affordable coverage," the report states.
Yet, there are other options to make health insurance plans more affordable for those Maryland residents who don't qualify for Medicaid.
Tax credits are given to those who make up to 400 percent of the federal poverty line or a single person who makes between $15,281.70 and $45,960, according to Maryland Health Connection.
The online application process will help determine if a person's income and family size qualifies them for monthly tax credits aimed at reducing the cost of monthly insurance premiums, according to Maryland Health Connection.
But those using tax credits should be aware that these subsidies are sensitive to change, Mortensen said, which could result in a person owing money back.
"If you're carefully reporting your income, the government will understand these fluctuations," she said, "and realize they exist, and they will toy around with what your subsidy is."
The goal of all this: to insure more Maryland residents, according to Milligan.
"One need not look far to see that, put simply, lives can change overnight when confronted with health care challenges. ... It is enough to worry whether you or a loved one will recover physically," Milligan wrote in the blog post explaining why Maryland expanded Medicaid.
"No one should have to add to that the economic and emotional pressure of catastrophic health bills."