What causes a coverage gap in Medicaid?

The coverage gap in Medicaid primarily arises when states choose not to expand Medicaid under the provisions of the Affordable Care Act. The ACA aimed to provide broader access to healthcare for low-income individuals by expanding Medicaid eligibility to those earning up to 138% of the federal poverty level. However, not all states opted into this expansion, leading to a situation where individuals who earn too much to qualify for traditional Medicaid but too little to qualify for subsidized insurance through the health insurance marketplace find themselves without coverage. This gap disproportionately affects low-income adults who fall within these income brackets, creating barriers to accessing necessary healthcare services.

Other factors like high insurance premiums and strict eligibility requirements may affect overall access to healthcare, but the core issue of the Medicaid coverage gap directly stems from state decisions regarding expansion. Insufficient federal funding does pose challenges in some contexts, but the primary cause of the gap itself is directly linked to the choices made by individual states regarding Medicaid's expansion.