A comprehensive review of state Medicaid policies by the Kaiser Family Foundation shows the dramatic differences in access to the public health program between states.

Much of the focus on Medicaid in recent years has centered on whether states choose to accept an expansion of the program, nearly entirely federally-funded, to cover all residents with incomes up to 138 percent of the federal poverty level as part of the Patient Protection and Affordable Care Act.

But even before PPACA, many policies regarding Medicaid eligibility differed significantly between the states. For some, Medicaid is a rather narrow program targeting only the very poorest residents or those considered to be a top priority for health care, such as children and pregnant women. For other states, Medicaid is a program that benefits many of the working poor and even middle class families.

Here are some examples of the differences between states:

In New York, children from families with incomes up to 405 percent of the FPL are eligible, whereas in Arizona the limit for children is only 152 percent of FPL.
In Iowa, pregnant women with incomes up to 380 percent of the FPL are eligible for Medicaid. In Alabama, only women up to 146 percent of the FPL are eligible.
In many non-expansion states, childless adults are ineligible for Medicaid. In Alaska, a childless adult with up to 215 percent of the FPL is eligible. In most expansion states, the limit is 138 percent of FPL.
In most states, there is no waiting period for enrollment in the Children's Health Insurance Program (CHIP), but a dozen states require applicants to wait up to 90 days to enroll.
30 states require families with children enrolled in Medicaid to pay premiums for their coverage if they have income above a certain threshold, which ranges from 133 percent in Utah to 249 percent in Connecticut. Meanwhile, 20 states charge no premiums to any person enrolled in Medicaid.
The amount charged to Medicaid enrollees differs dramatically as well. In Missouri, a family with an income of up to 300 percent of the FPL could pay up to $224 a month to cover a child, but the same family would only pay $40 a month in Iowa.

The good news, reports Kaiser, is the every state now allows people to enroll online, and all but one state permit enrollment over the phone.

“These changes are helping to connect eligible individuals to Medicaid coverage more quickly and easily and to keep eligible people enrolled as well as contributing to increased administrative efficiencies,” says the report.

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Medicaid rules differ dramatically by state

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