1. Who is Impacted by the Coverage Gap in States that Have Not Adopted the Medicaid Expansion?
June 2015

2. An estimated 41.3 million nonelderly individuals were uninsured in 2013.
268.9 M Nonelderly
NOTES: Medicaid and other public coverage includes: CHIP, other state programs, Medicare and military related coverage. The federal poverty level for a family of three in 2013 was $19,530.
SOURCE: Kaiser Family Foundation analysis of the 2014 ASEC Supplement to the CPS.

3. The majority of the uninsured are low-income adults, and more than half are people of color.
Asian/Native Hawaiian or Pacific Islander
Other
Children
White non-Hispanic
Childless Adults
Hispanic
Parents
Black
Total = 41.3 Million Uninsured
NOTES: The federal poverty level was $19,530 for a family of three in Data may not total 100% due to rounding. SOURCE: Kaiser Family Foundation analysis of the 2014 ASEC Supplement to the CPS.

4. Prior to the ACA, Medicaid eligibility was limited to specific low-income groups.
Not Eligible

5. Expanding Medicaid to low-income adults is a core component of the ACA coverage expansions.
Universal Coverage
Marketplaces With Subsidies For Moderate Income Individuals
Medicaid Coverage For Low-Income Individuals
Individual
Mandate
Health Insurance Market Reforms
Employer-Sponsored Coverage

6. As enacted, the ACA Medicaid expansion would cover adults up to 138% FPL in all states, filling long-standing gaps in coverage.
NOTES: 138% FPL = $16,242 for an individual and $27,724 for a family of three in 2015.

7. But, the Supreme Court effectively made the Medicaid expansion a state option.
Status of Medicaid Expansion Decisions, May 26, 2015 WY
WI* WV WA VA VT UT TX TN SD SC RI
PA* OR OK OH ND NC NY NM NJ
NH* NV NE
MT** MO MS MN
MI* MA MD ME LA KY KS
IA*
IN* IL ID HI GA FL DC DE CT CO CA
AR* AZ AK AL
Adopted (30 States including DC)
Adoption under discussion (3 States)
Not Adopting At This Time (18 States)
NOTES: Under discussion indicates executive activity supporting adoption of the Medicaid expansion. **MT has passed legislation adopting the expansion; it requires federal waiver approval. *WI covers adults up to 100% FPL in Medicaid, but did not adopt the ACA expansion.
SOURCE: “Status of State Action on the Medicaid Expansion Decision,” KFF State Health Facts, updated May 26, 2015.

8. Medicaid eligibility for adults remains limited in states that have not adopted the Medicaid expansion.
Median Medicaid/CHIP Income Eligibility Thresholds, April 2015
NOTES: State-reported eligibility levels as of January 2015, updated to reflect Medicaid expansion decisions as of April Eligibility levels are based on 2015 federal poverty levels (FPLs) for children, pregnant women, and parents in a family of three and for individual childless adults. In 2015,the FPL was $20,090 for a family of three and $11,770 for an individual. Thresholds include the standard five percentage point of the federal poverty level (FPL) disregard. *Montana has adopted the Medicaid expansion but implementation is pending waiver approval.
SOURCE: Based on results from a national survey conducted by the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families, 2015.

9. In states that have not adopted the Medicaid expansion, poor adults fall into a coverage gap, earning too much to qualify for Medicaid but too little for subsidies for Marketplace coverage.
44% FPL
$8,840 for parents
in a family of three
$11,770
for an individual
$47,080
for an individual
as of April 2015
as of October 2014

10. An estimated 3.7 million nonelderly adults fall into the coverage gap, most of whom reside in the South.
Distribution By State:
Distribution By Geographic Region:
Total = 3.7 Million in the Coverage Gap
NOTES: Excludes legal immigrants who have been in the country for five years or less and immigrants who are undocumented.
The poverty level for a family of three in 2015 is $20,090. Totals may not sum to 100% due to rounding.
SOURCE: Kaiser Family Foundation analysis based on 2014 Medicaid eligibility levels , updated to reflect state Medicaid expansion decisions as of March 2015, and 2014 Current Population Survey data.

11. More than half of adults in the coverage gap are adults of color
More than half of adults in the coverage gap are adults of color. Adults in the coverage gap are of varying age and health status.
Distribution By Race/Ethnicity:
Distribution By Age:
Distribution By Health Status:
Total = 3.7 Million in the Coverage Gap
NOTES: Excludes legal immigrants who have been in the country for five years or less and immigrants who are undocumented.
Totals may not sum to 100% due to rounding.
SOURCE: Kaiser Family Foundation analysis based on 2014 Medicaid eligibility levels , updated to reflect state Medicaid expansion decisions as of March 2015, and 2014 Current Population Survey data.

12. Two-thirds of adults in the coverage gap are in a family with a worker, but most work in jobs that are unlikely to offer insurance.
Family work status :
Firm size and industry among those working:
Other
Manufacturing/Infrastructure
100+ employees
Education/ Health
Professional/ Public Admin
50-99 employees
Agriculture/ Service
<50 employees
Total = 3.7 Million in the Coverage Gap
Total = 2.0 Million Workers in the Coverage Gap
NOTES: Excludes legal immigrants who have been in the country for five years or less and immigrants who are undocumented. Industry classifications: Agriculture/Service includes agriculture, construction, leisure and hospitality services, wholesale and retail trade. Education/Health includes education and health services. Professional/Public Admin includes finance, professional and business services, information, and public administration. Manufacturing/Infrastructure includes mining, manufacturing, utilities, and transportation.
SOURCE: Kaiser Family Foundation analysis based on 2014 Medicaid eligibility levels , updated to reflect state Medicaid expansion decisions as of March 2015, and 2014 Current Population Survey data.

13. Total Nonelderly Uninsured Adults
If all states expanded Medicaid, nearly six in ten uninsured Black adults would be eligible.
Share of Uninsured Adults Who Would be Eligible if All States Expanded Medicaid, by Race/Ethnicity:
Total Nonelderly Uninsured Adults
35.4 M
16.6 M
5.1 M
10.8 M
2.9 M
18.7 M
SOURCE: Kaiser Family Foundation analysis based on 2014 Medicaid eligibility levels, updated to reflect state Medicaid expansion decisions as of March 2015, and 2014 Current Population Survey data.

14. Total Nonelderly Uninsured Adults
However, uninsured Black adults are more likely to fall into the coverage gap than other racial/ethnic groups.
Share of Uninsured Adults Who Fall into the Coverage Gap, by Race/Ethnicity:
Total Nonelderly Uninsured Adults
35.4 M
16.6 M
5.1 M
10.8 M
2.9 M
18.7 M
SOURCE: Kaiser Family Foundation analysis based on 2014 Medicaid eligibility levels, updated to reflect state Medicaid expansion decisions as of March 2015, and 2014 Current Population Survey data.

15. If all states adopted the Medicaid expansion, the coverage gap would be eliminated and 64% of the nonelderly uninsured would be eligible for financial assistance.
Ineligible due to Immigration Status, 13%
Ineligible due to Immigration Status, 13%
Unsubsidized Marketplace/ESI Offer
Unsubsidized Marketplace/ESI Offer
Tax-Credit Eligible
Tax-Credit Eligible
Eligible for Financial Assistance
53%
Medicaid-Eligible Child, 10%
Eligible for Financial Assistance
64%
Medicaid-Eligible Child, 9%
Medicaid-Eligible Adult
20%
Medicaid-Eligible Adult
In the Coverage Gap, 9%
Based on Current Medicaid Expansion Decisions
If All States Expanded Medicaid
Total = 41.3 Million Nonelderly Uninsured
NOTES: Those ineligible for financial assistance include people with an affordable offer of ESI, individuals eligible to purchase unsubsidized Marketplace coverage, and individuals ineligible for coverage due to immigration status.
SOURCE: Kaiser Family Foundation analysis based on 2014 Medicaid eligibility levels, current expansion decisions (as of March 2015) and 2014 Current Population Survey.