Medicare Actuary Testifies: 24.7 Million New Medicaid Enrollees
Testifying before the House Energy and Commerce Committee this morning, Medicare actuary Rick Foster explained how the health care law may expand Medicaid BEYOND what the actuary’s office previously estimated. The updated estimate indicates that the Medicare actuary believes 24.7 million individuals will be dumped into the Medicaid program – an increase of nearly five million from its earlier estimates, and more than 8 million than estimated by the Congressional Budget Office.
The actuary explained the reasons for this significant adjustment this issue in testimony to the House Budget Committee:
In addition to the higher level of allowable income, the Affordable Care Act expands eligibility to people under age 65 who have no other qualifying factors that would have made them eligible for Medicaid under prior law, such as being under age 18, disabled, pregnant, or parents of eligible children. The estimated increase in Medicaid enrollment is based on an assumption that Social Security benefits would continue to be included in the definition of income for determining Medicaid eligibility. If a strict application of the modified adjusted gross income definition is instead applied, as may be intended by the Act, then an additional 5 million or more Social Security early retirees would be potentially eligible for Medicaid coverage.
In other words, if the new definition of income introduced in the law excludes Social Security benefits – and the actuary believes it does – upwards of an additional 5 million early retirees (along with some Social Security disability recipients) would be forced on to the Medicaid rolls. While officials at the Centers for Medicare and Medicaid Services have yet to opine on the official interpretation of “income” as defined by the law, it’s difficult to see how CMS could change in regulations definitions of income that are based in statute (i.e., the health care law and the Internal Revenue Code), meaning the actuary’s footnote is actually a possible, even likely, scenario. A total of nearly 25 million individuals added to the Medicaid rolls exceeds by more than 50% CBO’s estimate of 16 million individuals covered under the Medicaid expansion.
States are already facing record budget deficits, and the health care law imposes unfunded mandates of at least $118 billion. The Medicare actuary’s comments this morning mean that states could well face unfunded mandates MUCH higher than that amount.