Because some states have declined to expand their Medicaid program under the Affordable Care Act, more than a quarter-million veterans who don’t have health insurance will miss out on Medicaid coverage.

Under the new federal health law, expanding Medicaid eligibility is a key component which aims to offer coverage to the majority of uninsured Americans. In January, uninsured adults with incomes at or below 138 percent of the federal poverty level ($15,415 for an individual and $32,527 for a family of four) will become eligible for Medicaid benefits in those states that expand their programs.

(Related: Rural Areas Could Suffer In States That Opt Against Medicaid Expansion)

It is a common misconception that the nation’s 12.5 million non-elderly veterans receive health benefits through the Department of Veterans Affairs (VA). But only two-thirds of those veterans are eligible for VA health care while only one-third are enrolled.

There are roughly 1.3 million uninsured veterans nationwide.

In a recent report, it was was estimated by the Urban Institute that if every state embraced the new Medicaid rules, as many as 535,000 uninsured veterans and 174,000 veteran’s spouses would become eligible for Medicaid coverage.

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Unfortunately, last june the U.S. Supreme Court ruled that states were not required to expand their Medicaid programs. As a result, 23 states have declined to expand Medicaid, while another six have yet to make a final decision. There are close to 258,600 uninsured veterans in the 23 states that have rejected the expansion who would have been eligible for Medicaid, according to a Urban Institute report.

And with Obamacare taking effect in 2014, like most other Americans, the uninsured veterans will be required to get it by January or risk paying a penalty under the Affordable Care Act. However, some of the uninsured who fail to qualify for Medicaid coverage might be eligible for federal subsidies that will be made available under the law. Uninsured Americans–veterans and non-veterans–will be able to use those subsidies to purchase private insurance on the state health care exchanges, set to launch in January.

There is a growing fear that Medicaid expansion and the array of health insurance choices available to veterans would result in worse care. The federal government created a separate VA health care system in the belief that veterans would get better care from doctors and nurses versed in the unique health conditions facing them, including post-traumatic stress in addition to other mental illnesses and physical injuries. But the Department of Veterans Affairs only expects 66,000 uninsured veterans to enroll in the VA system to meet the insurance requirement under the new health law.

(Related: Where Does Michigan Stand on Medicaid Expansion?)

Income limits for VA benefits are significantly less stringent than they are for Medicaid. A veteran with no dependents and an annual income of as much as $30,978 is eligible. But conditions other than income–like the length of time since combat, service medals, and service-related injuries or illnesses– also affect eligibility for VA health benefits.

Furthermore,, “there may be a variety of factors why a veteran would choose (Medicaid) or the (VA), such as proximity to VA facilities or their knowledge of the fact that VA care is available to them,” according to Jennifer Haley, who co-authored the Urban Institute report.

Read more: http://www.themonitor.com/news/local/article_035861f0-c972-11e2-8d60-001a4bcf6878.html

Christopher J. Berry is a Michigan elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.michiganelderlawattorney.com/ or call 248.481.4000

Rural areas could suffer in states that opt against Medicaid expansion.

The goal of Medicaid expansion under the Affordable Care Act is supposed to cover more of the working poor and balance out cuts that were made to already-struggling hospitals. However, Republican-led states have been opting out or holding out, while outlying areas in states like Tennessee may be the most severely impacted.

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Partners for Healing in Tullahoma, Tenn., offers care exclusively to the uninsured workers — and there’s a number of them in the town of 18,000 — with a number of studies indicating that rural Americans are more likely to have low-wage jobs, and no insurance.

Kentucky Democrat Governor Steve Beshear announced that he will expand Medicaid coverage and nearly cut the state’s uninsured population in half. The expansion will extend coverage to adults earning up to 133 percent of the federal poverty line, providing public health assistance to more than 300,000 people.

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Those pushing for Medicaid expansion credited GOP lawmakers for putting forth a House bill for discussion. Senate Republicans met behind closed doors to discuss the plan but failed to reach a consensus.

(Related: How Much Will Medicaid Cost in the Future and Why: Federal Projections)

A health advocacy group has developed a compromise proposal in hopes of ending the debate in California of how to expand Medi-Cal. Health Access California proposes a time frame and percentages for the state and countries to share $1.4 billion in savings when Medi-Cal coverage is expanded next year. State and county officials have been playing tug-a-war with how the windfall should be divided.

Read more: http://www.kaiserhealthnews.org/Daily-Reports/2013/May/10/medicaid-expansion.aspx

Christopher J. Berry is a Michigan elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.michiganelderlawattorney.com/ or call 248.481.4000