Obamacare: the gap between Medicaid and exchange

My family and I Iive in Indiana. My spouse is on SSI and gets a weekly Worker Comp check, both are non- taxable. Our 14 year old son and I were told we don’t qualify for anything in the Affordable Care Act . I was told to sign up for Healthy Indiana Plan (HIP) for myself and Hoosier Healthwise for our son. I am currently waiting of my HIP results but have been told for the second time my son can’t get Healthwise because our income is too much. So he is 14 with no coverage. What options are there for families like us?

Still Looking

Dear Still Looking,

The information you have been given is correct, and I can see why it is frustrating. Let me explain. Indiana did not “expand” Medicaid to cover all low-income families. Your family “modified adjusted gross income” – taxable or non-taxable – is higher than Medicaid’s guidelines. However, it is too low to allow you to get subsidies to buy insurance on the exchange. There is a gap between qualifying for Medicaid and qualifying for the exchange subsidies, in other words, in states that did not expand Medicaid. In that gap, you qualify for neither. You are in that gap.

Indiana is investigating ways to expand Medicaid, however. Keep an eye out for news on this.

In the meantime, ask your doctor and hospital to refer you to free or sliding-scale clinics. All hospitals have free care programs; you only need to apply. You can find directories of these clinics on line too.

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Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.