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More people will be eligible for Medicaid as of Jan. 1


Beginning Jan. 1, the income eligibility level for Medicaid will rise to 138 percent of the federal poverty level, therefore increasing the number of people under age 65 who qualify for the federal health insurance.

Under current guidelines, individuals are eligible for Medicaid if their annual income is below about $9,000 a year, but the maximum income will increase to $15,856 as of Jan. 1. A family of four will be eligible with an annual income up to $32,499.

“People who are living below the federal poverty level tend to be sicker and use emergency rooms,” said Steve Wood, community health coordinator of Community Health Advocates, a program offered through ACR Health. “People using emergency rooms are a huge drain on our economy.”

The Medicaid expansion will allow people who previously were not eligible, or who did not have insurance, to seek preventive health and other essential health benefits. The idea, Mr. Wood said, is to keep people well so they don’t have to use emergency rooms as a means for basic, non-emergency care.

According to, the federal Patient Protection and Affordable Care Act fills in gaps in coverage for the poorest Americans by increasing the eligibility level. Eligibility and enrollment will be coordinated through the health insurance marketplace.

That’s when patient navigators may assist people, if they want to know their plan options.

The expansion of Medicaid also may push local providers to expand what insurance plans they accept or participate in, Mr. Wood said, therefore giving Medicaid recipients more provider options. Samaritan Medical Center spokeswoman Krista A. Kittle said the Medicaid expansion pairs with Samaritan’s recent decision to open up more appointment slots with physician assistants and nurse practitioners at Samaritan’s Plaza Family Health Center, outer Washington Street.

All six of Samaritan’s health centers accept Medicaid, she said. Samaritan also will continue to recruit primary care providers.

Various community clinics, such as the North Country Family Health Center, Watertown, and the Community Health Center of the North Country in both Gouverneur and Canton, accept Medicaid.

The Medicaid expansion also comes as a time when Excellus BlueCross BlueShield could pull out of Medicaid Managed Care in the state. The insurer had cited poor reimbursement rates as the factor, as the health plan in 25 counties “is incurring losses approaching $100 million in 2013.” More than 25,000 people across Jefferson, Lewis and St. Lawrence counties may have to switch their Medicaid Managed Care or Family Health Plus insurance program provider, as Excellus is making plans to drop out of those programs, effective Jan. 1.

Excellus, however, is working with the state Department of Health to try to avoid that.

Mr. Wood said there are also reports that some people are being dropped from their plans, and he said that is a result of insurers not preparing for the federal act changes, which have minimum standards of care included in all plans. Also called essential health benefits, those standards of care include prescriptions, mental health, maternity, hospital and emergency care, among others.

According to the Kaiser Family Foundation, Medicaid eligibility income levels for working parents alone were just 64 percent of the federal poverty level before the federal act took place. While there had been varying levels of eligibility based on age, most income eligibility levels are now 138 percent of poverty.

For more information on the Medicaid expansion, visit

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