SPDP

  State Policy Documentation Project

 

 


Table 1:  States' Implementation of the Requirement to Replace
the Automatic Eligibility Link between Medicaid and Welfare
with a Family Coverage Category

This table is designed to provide basic information on whether states have established a family coverage category (as required under federal law), as well as whether families with children have access to Medicaid through alternative routes.  Note that most children are eligible for Medicaid at significantly higher income and asset levels under categories other than the family coverage category (e.g., the poverty level eligibility groups for children). Thus, the family coverage category rules described in this table primarily determine the extent to which parents are eligible for Medicaid coverage. In states without a family coverage category, this table provides information on the alternative circumstances under which parents can gain access to Medicaid. (For state-specific information on the income level at which children are eligible for Medicaid, see the table prepared by the Center on Budget and Policy Priorities at http://www.cbpp.org/shsh/elig.htm.)

Column 1 answers the basic question of whether a state has established a family coverage category.

Column 2 identifies whether those states that have not yet implemented the federal requirement to create a family coverage category nevertheless provide coverage to some parents who are not on welfare. The states without family coverage categories may have extended Medicaid to parents in one of two ways:

  • Medically needy category — Some states without a family coverage category do have a "medically needy" eligibility category for families with children that can be used to cover parents who are ineligible for or who elect not to be on TANF. (These states also generally provide Medicaid to all families on TANF.) The medically needy eligibility category for families with children is an optional Medicaid eligibility category that covers families who have income and assets below state-established medically needy standards or who fall below these standards after they "spend down" their "excess" income and assets on medical bills. Traditionally, the medically needy eligibility category has been used by states primarily for people with high medical bills, but, in some states, it also can serve as a source of coverage for other parents if their income and assets are below medically needy standards even when medical bills are not taken into account.
  • 1115 waiver — Some states without a family coverage category have expanded Medicaid to parents under a section 1115 Medicaid waiver. Note that the terms of the Medicaid coverage available to parents under a waiver may vary from what is available to them under a state’s regular Medicaid program.

Column 3 indicates whether a state covers parents via a Medicaid expansion enacted under an 1115 waiver and, if so, describes the extent of the expansion. Note that some states with 1115 waiver expansions also have established a family coverage category, while others have not. The column describes the coverage of "parents" because children are eligible for Medicaid in almost every state at significantly higher income levels under alternative Medicaid eligibility categories.

 

State Family coverage category established If no, is there a route to coverage for families with children who are not on welfare? Has the state enacted a Medicaid expansion under an 1115 waiver that covers parents regardless of their welfare status?
Totals   46  Yes
  5  No
   9   Yes
42  No
Alabama

Yes

n/a

No

Alaska

Yes

n/a

No

Arizona

Yes

n/a

No

Arkansas

Yes

n/a

No

California

Yes

n/a

No

Colorado

Yes

n/a

No

Connecticut

Yes

n/a

No

Delaware

Yes

n/a

Yes, covers all uninsured adults with countable income up to 100% of FPL

District of Columbia

Yes

n/a

No

Florida

Yes

n/a

No

Georgia

Yes

n/a

No

Hawaii

No

Yes, via Medicaid expansion enacted under an 1115 waiver; HI also provides Medicaid to all TANF recipients

Yes, covers parents with gross income up to 100% of FPL

Idaho

Yes

n/a

No

Illinois

Yes

n /a

No

Indiana

Yes

n/a

No

Iowa

Yes

n/a

No

Kansas

Yes

n/a

No

Kentucky

Yes

n/a

No

Louisiana

Yes

n/a

No

Maine

Yes

n/a

No

Maryland

Yes

n/a

No

Massachusetts

No

Yes, via Medicaid expansion enacted under an 1115 waiver; MA also provides Medicaid to all TANF recipients

Yes, covers all parents with gross income up to 133% of FPL

Michigan

Yes

n/a

No

Minnesota

Yes

n/a

Yes, covers parents with gross income up to 275% of FPL

Mississippi

Yes

n/a

No

Missouri

Yes

n/a

Yes, covers uninsured working parents with countable income up to 100% of FPL

Montana

Yes

n/a

No

Nebraska

No

Yes, via medically needy category; NE also provides Medicaid to all TANF recipients

No

Nevada

Yes

n/a

No

New Hampshire

Yes

n/a

No

New Jersey

Yes

n/a

No

New Mexico

Yes

n/a

No

New York

Yes

n/a

No

North Carolina

Yes

n/a

No

North Dakota

Yes

n/a

No

Ohio

Yes

n/a

No

Oklahoma

Yes

n/a

No

Oregon

Yes

n/a

Yes, covers parents with gross income up to 100% of FPL

Pennsylvania

Yes

n/a

No

Rhode Island

Yes

n/a

No

South Carolina

Yes

n/a

No

South Dakota

Yes

n/a

No

Tennessee

Yes

n/a

Yes, covers parents who have lost eligibility for regular Medicaid under the "family coverage" category up to 400% of FPL

Texas*

No

Yes, via medically needy category; TX also provides Medicaid to all TANF recipients

No

Utah

No

Yes, via medically needy category; UT also provides Medicaid to all TANF recipients

No

Vermont

Yes

n/a

Yes, covers parents with countable income up to 150% of FPL

Virginia

Yes

n/a

No

Washington

Yes

n/a

No

West Virginia

Yes

n/a

No

Wisconsin

Yes

n/a

Yes, covers parents up to 185% of FPL and allows them to remain enrolled until their income reaches 200% of FPL

Wyoming

Yes

n/a

No

* Texas plans to provide Transitional Medicaid Assistance to families with income below TANF limits in the state’s medically needy eligibility category whose new or increased earnings or child support causes the family’s income to exceed the TANF limits. When it does so, the state’s medically needy eligibility category will serve a function identical to the family coverage category the state is required to create by federal law.


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This page last updated September 02, 2023

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