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To thwart Medicaid expansion, states set high bars for eligibility

Sandra Pico of Florida expects to remain uninsured after her governor said he would not extend Medicaid coverage.

Lynne Sladky/Associated Press

Sandra Pico of Florida expects to remain uninsured after her governor said he would not extend Medicaid coverage.

MIAMI — Sandra Pico is poor, but not poor enough.

She makes about $15,000 a year, supporting her daughter and unemployed husband. She thought she’d be able to get health insurance after the Supreme Court upheld President Obama’s health care law.

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Then she heard that her own governor will not agree to the federal plan to extend Medicaid coverage to people like her in two years. So she expects to remain uninsured, struggling to pay for her blood pressure medicine.

“You fall through the cracks, and there’s nothing you can do about it,” said the 52-year-old home health aide. “It makes me feel like garbage, like the American dream, my dream in my homeland, is not being accomplished.”

Many working parents like Pico are below the federal poverty line but do not qualify for Medicaid, a decades-old state-federal insurance program. That is especially true in states where conservative governors say they will reject the Medicaid expansion under Obama’s health law.

In South Carolina, a yearly income of $16,900 is too much for Medicaid for a family of three. In Florida, $11,000 a year is too much. In Mississippi, $8,200 a year is too much. In Louisiana and Texas, earning more than $5,000 a year makes you ineligible for Medicaid.

Governors in those five states have said they will reject the Medicaid expansion underpinning Obama’s health law after the Supreme Court’s decision gave states that option. Many of those hurt by the decision are working parents who are poor — but not poor enough to qualify for Medicaid.

Republican Mitt Romney’s new running mate, conservative Wisconsin Representative Paul Ryan, has a budget plan that would turn Medicaid over to the states and sharply limit federal dollars. Romney has not specifically said where he stands on Ryan’s idea, but has expressed broad support for his running mate’s proposals.

Medicaid now covers an estimated 70 million Americans and would cover an estimated 7 million more in 2014 under the Obama health law’s expansion. In contrast, Ryan’s plan could mean 14 million to 27 million Americans would ultimately lose coverage, even beyond the effect of a repeal of the health law, according to an analysis by the nonpartisan Kaiser Family Foundation of Ryan’s 2011 budget plan.

In San Juan, Texas, Matthew Solis, 22, makes about $8,700 a year — too much to qualify for Medicaid in that state. Solis, a single father with joint custody of his 4-year-old daughter, said he works about 25 hours per week at a building supply store making minimum wage and is a full-time student at the University of Texas-Pan American.

He recently sought medical care for food poisoning, visiting a federally funded clinic. But he does not see a doctor regularly because he can’t afford private insurance. The new health law allows young adults to remain on their parents’ insurance until age 26. But that doesn’t help Solis, whose father is uninsured and whose mother died of leukemia when he was 8.

“I voted for him [Obama] because he promised we would have insurance,” Solis said. “I’m pretty upset because I worked for Obama and I still don’t have coverage.”

His governor, Rick Perry, like Pico’s governor, Rick Scott, is rejecting the Medicaid expansion.

In most of the states where governors are rejecting or leaning against the expansion, the income level that disqualifies a parent from Medicaid is stunningly low. Most states base Medicaid eligibility for parents on household income and how it compares to the federal poverty level, which was $18,530 for a family of three in 2011.

In Louisiana, the eligibility cutoff for a working parent is 25 percent of federal poverty, or $4,633 for a family of three. In Nevada, it is 87 percent of the federal poverty level, or $16,121 for a family of three.

That has been the range in states where governors are probably saying no to expanded Medicaid. In contrast, states where governors have said they will expand Medicaid are more generous with working parents. The Medicaid eligibility cutoff ranges in those states from Washington’s $13,527 to Minnesota’s $39,840.

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