Information on the Medicaid Expansion

Medicaid is a health insurance program that helps individuals and their families, who may not be able to afford health care coverage.

Currently, to qualify for Medicaid in VA, you must meet all of these criteria:

  • A resident of the state and a U.S. citizen or qualified legal immigrant,
  • In need of health care/insurance assistance with low/very low income (133% of the Federal Poverty Line)
  • Must also be either:
    • Pregnant, the parent or relative caretaker of a dependent child(ren) under age 19, under 21 and in foster care, disabled, 65 years of age or older

The Affordable Care Act creates a new national Medicaid income eligibility level at 133% of the Federal Poverty Line ($15,528 for an individual and $31,322 for a family of four) – if VA approves expansion, about half of Virginians who are currently uninsured will be able to get health insurance through Medicaid. Virginia is unlikely to expand Medicaid prior to July 2014.

The Health Insurance Marketplace

Pursuant to the federal affordable Healthcare Act (“Obamacare”), individuals in the Commonwealth who do not currently have health insurance and who are not eligible for Medicaid will be able to shop for insurance coverage from a “Health Insurance Marketplace” (a.k.a. “Health Insurance Exchanges”) for a  variety of options that fit their budget and needs. States have the option to take-part in the federally run Marketplace or run their own from within the state; VA has opted to participate in the federal health insurance Marketplace.

The Marketplace will offer four coverage levels: bronze, silver, gold, and platinum. To assist low income individuals in affording the insurance, a person (or family) may qualify for a tax credit. The dollars from the credit will go directly to the health plan in which the person (or family) enrolls, helping to offset the total cost for the health plan. Navigators, people trained to help with the Marketplace, should be located throughout the community to help individuals with their insurance applications.

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