The Affordable Care Act

The Affordable Care Act (ACA) is the new law that requires most people to have health insurance. There are also some new health insurance choices as of October 2013.

You may have questions about how the ACA impacts you as a Medicaid member. You may also be looking to Medicaid as a possible way to get the required insurance coverage.

Medicaid Changes for Current Members

As a current Medicaid member, you will not notice many changes.  You do not have to reapply or provide any additional information simply due to the ACA.  You may notice a change when it is time for you to have your annual redetermination, but these changes will not impact your Medicaid benefits.  You will be notified by mail when it is time for your redetermination.

You may notice that different information is collected at your redetermination.  If you were eligible for coverage before, you will most likely still qualify for coverage.  When you have gone through a redetermination, you may notice a change in the name of your aid category.  This will not impact your Medicaid benefits or the services that you receive.

Change in Eligibility Rules

For children, pregnant women, and families who apply for Medicaid, the Affordable Care Act changes the way income is counted in the process of determining eligibility.  These new rules are called Modified Adjusted Gross Income (MAGI).  The income on which you must pay taxes will be counted in determining if you qualify for Medicaid.   Your resources will no longer be reviewed for Medicaid eligibility. Resources are items like bank accounts, cars, or houses.  Note:  Not all people who apply for Medicaid will have their income counted with MAGI rules. If you are disabled or have Medicare, there will be no changes from today's eligibility rules.

Is Medicaid an Option for Me?

Medicaid is mostly for kids, pregnant women, low income families, and people who are disabled.  You may be able to qualify for Medicaid if you:

  • are under 19 years old;
  • are pregnant; or
  • are the parent of a child under 18 years old.

If you belong to one of these groups and make less than a certain amount of money each year, you may qualify for Medicaid.

See the following tables for the newest financial eligibility rules for each aid category for Medicaid eligibility beginning January 1, 2014:

Table of family size and income for low income families

Family Size

Income Limit Per Month

1

$152.00

2

$247.00

3

$310.00

4

$373.00

5

$435.00

Table of family size and income for children under 19

(Hoosier Healthwise Package A)

Family Size

Income Limit Per Month

1

$1,513.00

2

$2,043.00

3

$2,572.00

4

$3,101.00

5

$3,631.00

Table of family size and income for children under 19

(Hoosier Healthwise Package C*)

Family Size

Income Limit Per Month

1

$2,394.00

2

$3,232.00

3

$4,069.00

4

$4,907.00

5

$5,744.00

*You may have a premium in this program

Table of family size and income for pregnant women

Family Size

Income Limit Per Month

1

$1,992.00

2

$2,689.00

3

$3,386.00

4

$4,082.00

5

$4,779.00

Table of family size and income for the Healthy Indiana Plan (HIP)

Family Size

Income Limit per month

1

$958.00

2

$1,293.00

3

$1,628.00

4

$1,963.00

5

$2,298.00

If you are not otherwise eligible for Medicaid, a 5% income disregard will be applied.

If you earn more money than listed above and do not have insurance through your job, you may want to go to the federal Health Insurance Marketplace and learn more about other health coverage options.  You may qualify for a tax credit to pay for some of your health insurance costs. Visit www.healthcare.gov for more information.

Frequently Asked Questions

For some frequently asked questions regarding the Affordable Care Act, click here.