States Can't Get Full Federal Funding for Partial Medicaid Expansion

Under the Affordable Care Act, states will be eligible for greatly increased federal-match payments beginning in 2014 if they expand their Medicaid programs to cover adults with incomes up to 133% of the Federal Poverty Level (FPL).  In a letter dated December 10, 2012, Secretary of Health and Human Services (HHS) Kathleen Sebelius said that states have "flexibility in Medicaid and the Children's Health Insurance Program (CHIP) to provide premium assistance for Exchange plans as well as to adopt 'bridge plans' that offer coverage through both Medicaid and Exchanges…"  The Secretary also noted, however, that flexibility is limited regarding federal funding for Medicaid expansion.  The Affordable Care Act, she stated, does not create an option for enhanced federal-match funding for a partial or phased-in Medicaid expansion.  In other words, states cannot partially expand their Medicaid programs and still receive 100% federal-match for two years, and 90% thereafter.

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2013 Medicare Cost-Sharing

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Hospital Deductible: $1,184 per spell of illness
Hospital Coinsurance:

• Days 0-60: $0
• Days 61-90: $296 / day
• Days 91-150: $592 / day

Skilled Nursing Facility Coinsurance

• Days 0-20: $0
• Days 21-100: $148 / day

Part A Premium (for voluntary enrollees only)

• With 30-39 quarters of Social Security coverage: $243 / month (no change)
• With 29 or fewer quarters of Social Security coverage: $441 / month

Part B

• Deductible: $147 / year
• Standard Premium: $104.90 / month

Part B Income-Related Premium

Beneficiaries who file an individual tax return with income:	Beneficiaries who file a joint tax return with income:	Beneficiaries who are married, but file a separate tax return with income:	Income-related monthly adjustment amount	Total monthly Part B premium amount
Less than or equal to $85,000	Less than or equal to $170,000	Less than or equal to $85,000	$0.00	$104.90
Greater than $85,000 and less than or equal to $107,000	Greater than $170,000 and less than or equal to $214,000		$42.00	$146.90
Greater than $107,000 and less than or equal to $160,000	Greater than $214,000 and less than or equal to $320,000		$104.90	$209.80
Greater than $160,000 and less than or equal to $214,000	Greater than $320,000 and less than or equal to $428,000	Greater than $85,000 and less than or equal to $129,000	$167.80	$272.70
Greater than $214,000	Greater than $428,000	Greater than $129,000	$230.80	$335.70

Part D Income-Related Premium Adjustment
Enrollees in Medicare Part D prescription drug plans pay premiums that vary from plan to plan.  Since 2011, Part D enrollees whose incomes exceed the same thresholds that apply to higher income Part B enrollees must also pay a monthly adjustment amount. The regular plan premium will be paid to their Part D plan, and the income-related adjustment will be paid to Medicare.  The base beneficiary premium for 2013 is $31.17.

Beneficiaries who file an individual tax return with income:	Beneficiaries who file a joint tax return with income:	Beneficiaries who are married, but file a separate tax return with income:	Part D Income-related monthly adjustment amount
Less than or equal to $85,000	Less than or equal to $170,000	Less than or equal to $85,000	$0
Greater than $85,000 and less than or equal to $107,000	Greater than $170,000 and less than or equal to $214,000		$11.60
Greater than $107,000 and less than or equal to $160,000	Greater than $214,000 and less than or equal to $320,000		$29.90
Greater than $160,000 and less than or equal to $214,000	Greater than $320,000 and less than or equal to $428,000	Greater than $85,000 and less than or equal to $129,000	$48.30
Greater than $214,000	Greater than $428,000	Greater than $129,000	$66.60