Health Care Concept. Doctor holding a jigsaw puzzle with MEDICAID word.
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Findings from new research at the LeadingAge LTSS Center @UMass Boston dispel policymaker fears that adding more recipients to the Medicaid program by using alternative eligibility criteria would bankrupt the program. Those newly eligible individuals would benefit “tremendously” from coverage, the researchers wrote in sharing findings recently in the Journal of Aging & Social Policy.

“We’re not talking about a massive number of additional people,” the researchers said.

Medicaid’s eligibility rules rely on income standards based on the federal poverty level, with stringent limits on financial assets that exclude many older adults who are financially and and physically vulnerable. 

To quantify how many more people could be helped with varying eligibility standards, the researchers used data from the Health and Retirement Study to look at five alternative criteria:

  • The Supplemental Poverty Measure, which factors in taxes and healthcare costs, as well as some noncash benefits, as income.
  • The Elder Index — developed by the Gerontology Institute at the University of Massachusetts Boston — which determines the basic cost of living for older adults and includes the costs of housing, healthcare, transportation and food.
  • 138% of the federal poverty level — the threshold for younger, nondisabled adults.
  • Allowance for household assets of up to $7,970 for single adults and up to $11,960 for couples.
  • No limits on household assets.

Under current eligibility standards, 6.9 million people qualify for Medicaid. The number of additional qualified participants under the alternative eligibility criteria was 11.5 million using the Elder Index, 4.7 million under federal poverty level alternative guidelines, 2 million with unlimited assets, 1.4 million raising the asset limit, and 700,000 using the Supplemental Poverty Measure.

In using the alternative criteria, the researchers found people who probably already should be receiving Medicaid and that creating access to more preventive care for additional participants could provide potential healthcare savings down the road.

“Pulling different levers really changes the profile of who qualifies,” research fellow Jane Tavares, PhD, said in a statement. “We have a huge wealth gap in the US for racial and ethnic minorities. If you raise the income limit, you bring in more people of color who don’t tend to have saved assets. If you raise the limit on household assets, you bring in a lot more white people.”

The bottom line, according to researchers, is “we’re not talking about a massive number of additional people. And they look like people who could benefit tremendously from the coverage.”

“The study clearly demonstrates that a large number of financially and health-vulnerable older adults are excluded from the Medicaid program under current policy,” the researchers concluded. “The study highlights the implications for policymakers of updating Medicaid financial eligibility standards to assure that Medicaid benefits are targeted to vulnerable older adults who need them.”

The study was supported by the Community Catalyst National Council on Aging.