Health Policy and Research Solutions

Kansans with Incomes at or Below 138 Percent of the

Federal Poverty Level:

County Distributions

INTRODUCTION

The Patient Protection and Affordable Care Act, known as the Affordable Care Act (ACA), was passed into

law in March 2010. Two years later, public opinion remains strongly divided on health reform, as structured in

the ACA. Whatever one’s position, information about the law can inform actions.

The ACA is intended to extend health insurance to millions of United States citizens who currently do not

have coverage. This ACA extension would occur by insuring individuals, expanding Medicaid and providing

POPULATION

BRIEF©

March 2012

This is the third in a series

of briefs created by Health

Policy and Research

Solutions.

Written by

Sharon Barfield, MSW, LSCSW

http://hprsolutionsllc.com

(All Rights Reserved)

subsidies to help individuals with low incomes buy coverage through newly

established Health Benefit Exchanges, functioning as insurance marketplaces.

The law expands Medicaid to persons under age 65 with incomes at or

below 138 percent of the Federal Poverty Level (FPL) starting January 1, 2014.

The FPL is the amount of income at which the federal government considers

someone to be living in poverty. The FPL for one person in 2012 is a gross

annual income of $11,170. The 138 percent of FPL represents a $15,415 gross

annual income for an individual or $26,344 for a family of three.

Some confusion surrounds the income-eligibility threshold for the potential

new Medicaid population. Some sources cite 133 percent of the FPL while

others cite 138 percent. An explanation appears below in the data section.

The Medicaid expansion would help reduce state-by-state variations in

eligibility for the program. For example, Kansas is among the 10 states with the

lowest income eligibility thresholds for parents. Based on eligibility

requirements, currently Kansas adults typically do not qualify for Medicaid

unless they have low incomes and are disabled, elderly or pregnant. Parents of

minor children may qualify if they have very low incomes. A single parent with

_____________________________________________________________________________________________ http://hprsolutionsllc.com - 1 - Population Brief 3.3/March 2012

two children normally must have

a gross monthly income of less

than $430 to qualify. If this single

parent resided in some other

states with higher eligibility

thresholds, they could earn more

income and still qualify for

Medicaid.

A significant expansion

population is persons who do not

currently have health insurance

and would be eligible for Medicaid

under the ACA. To defray costs to

the states, enhanced federal

funding will be available to

finance the “newly eligible” as

follows:

100% for three years from

2014-2016

95% federal funds in 2017

94% federal funds in 2018

93% federal funds in 2019

90% federal funds in 2020

and beyond

After enrollment, new

beneficiaries could access

healthcare services via Medicaid.

WHAT ABOUT THE SUPREME COURT RULING?

The U.S. Supreme Court is

expected to rule on the

constitutionality of the Individual

Mandate of the ACA, the provision

that requires most individuals to

have health insurance or pay a

penalty. This decision is expected

in June 2012. As described in an

earlier brief, it appears that the

ACA may survive in some form.

The Court has announced that it

will also hear challenges to the

Medicaid expansion called for in

the law.

The Court’s opinions will guide

insurance coverage and access to

health care for groups of people

across the nation. Individuals

earning low incomes are more

likely to be uninsured and have

lapses in insurance than other

earners. Even if insured, they are

more apt to be underinsured, to

have coverage that inadequately

covers their healthcare services.

If the Court rules against the

ACA’s Medicaid expansion, many

who would otherwise have

become Medicaid beneficiaries

will not have health insurance

coverage. Being able to pinpoint

where these persons reside could

inform efforts to help them gain

coverage or to access needed

health care other ways, such as

through the patchwork of safety

net clinics. In addition, healthcare

providers could use this

information to strategize for

financial assistance and writing

off uncompensated care.

Conversely, if the Court does

not uphold challenges to the

Medicaid expansion, this

information could inform ACA

planning and implementation for

the expansion. Providers could

also use the knowledge for

decisions in terms of expansion

and expected revenue. Moreover,

managed care organizations could

utilize the evidence for their

operations.

With this Medicaid expansion

possible but uncertain, this brief

paints a demographic picture of

where Kansans who may become

eligible for it live.

THE DATA As indicated, some confusion

exists about whether the ACA

Medicaid expansion eligibility

threshold is 133 or 138 percent of

FPL. According to initial language

in the ACA, childless adults whose

gross yearly income is less than or

equal to 133 percent of the FPL

are eligible for Medicaid coverage.

However, a complicated set of

provisions later contained in the

ACA raises the Medicaid eligibility

threshold to 138 percent of the

FPL. So, states will want to

include childless adults up to 138

percent of FPL when planning for

Medicaid expansions.

This brief uses the most recent

population and income estimates

released by the U. S. Census

Bureau (2009) for each county in

the U.S. The Census Bureau

produces estimates of state and

county populations and their

characteristics, using

demographic and income

modeling. The data used for this

modeling include inputs such as

from surveys (e.g., American

Community Survey), income tax

returns and the Census.

Based on these estimates, this

publication provides the

estimated number of residents of

each Kansas County under age 65

in 2009 with incomes at or below

138 percent of the FPL. It also

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gives what percentage the

population at 138 percent FPL

was of each county’s entire

population under 65.

These data and findings exclude

people 65 and older because, due

to Medicare, almost all of them are

insured. Since children currently

covered by CHIP, the Children’s

Health Insurance Program, living

in families with incomes between

100 and 133 percent of the FPL

would be transitioned to the new

Medicaid program and some now

remain uninsured, this brief

includes children.

MAPS

ILLUSTRATE

PATTERNS Map 1 graphically depicts

the estimated percentages

of persons at 138 percent

FPL for each Kansas

County.

The percentages ranged

from 8.2 to 47.2 and are

presented in quintiles

(five segments), with each

quintile’s range shown in

the legend of Map 1.

Counties falling in the top

quintile with the highest

percentages are colored

red and counties falling in

the bottom quintile with

the lowest percentages are

colored beige. Gold, gray

and orange denote

counties in the middle three quintiles.

McPherson, Elk, Geary and Wyandotte Counties had

the highest estimated

percentages of inhabitants

at 138 percent FPL

Marion, Johnson, Leavenworth and Miami

Counties were home to the

lowest estimated

percentages of residents at

138 percent FPL (8.2%,

9%, 14.8% and 14.9%).

An estimated 20.4 percent of all Kansans had incomes

at 138 percent of FPL.

The highest percentages of

Kansans with incomes in

the subject range were

concentrated in the

southeast but scattered

northward. They included

McPherson, the county

with the highest

percentage, which nestles

about in the middle of the

state. Almost half of

McPherson’s population

had incomes at 138 percent

FPL. Map 1 discloses other

high-percentage counties

situated in the southwest

and northwest.

Counties colored beige

with the lowest percentages

of residents at 138 FPL

were concentrated

primarily in the

northeastern portion of the

state. However, pockets of

counties with similar

compositions appeared in

the middle to eastern as

well as the middle-

western parts of the state.

The numbers ranged from

166 to 88,017 and are presented in quintiles, as

indicated on Map 2.

On Map 2, which displays the numbers of

inhabitants at 138

percent FPL, the pattern

flips. Beige counties,

indicating small numbers

of residents, are heavily

concentrated in the rural

west. The bulk of counties

in red are positioned in

the eastern, more urban

parts of the state, with

some scattered in the

west.

Counties with the highest

estimated numbers of

residents with incomes at

138 percent FPL were

Sedgwick, Wyandotte,

Johnson and Shawnee

(88,017, 43,929, 42,581

and 32,700 respectively).

Counties with the lowest

estimated numbers of

inhabitants at 138 percent

FPL were Greeley, Lane,

Comanche and Wallace

(166, 257, 287 and 299).

Of course, counties with

larger populations have

larger numbers of people

in specified groups,

including those with

incomes at or below 138%

of FPL. It is important to

note though that, for _____________________________________________________________________________________________ http://hprsolutionsllc.com - 3 - Population Brief 3.3/March 2012

example, although only 8

percent of Johnson County

residents earned low

incomes, this percentage

represented about 42,600

people.

A total of 488,159 Kansans

had incomes at 138

percent FPL.

In addition to the highest

and lowest percentages

and numbers in the top

and bottom quintiles,

other quintiles illustrate

the many degrees of

variations among the

counties geographically as

well as the values within

the quintiles.

DISCUSSION

Whatever happens at the

federal level with the Supreme

Court decision, Kansans with

incomes at or below 138 percent

of FPL will need health care. With

the Medicaid expansion, the state

exchange could use the county-

level population and income

information in this brief to inform

its planning and implementation

of the Medicaid expansion under

the ACA. For example, this

publication provides insights into

where Kansans who may qualify

for the new Medicaid program

reside and where targeted

outreach and education efforts

might be most beneficial. Without

the expansion, policymakers and

stakeholders could use this same

content to aid efforts to promote

alternative modes of access to

healthcare services for Kansans

with low incomes.

Health, however, is holistic,

encompassing multiple aspects of

life to be considered when

generating policy and practice

solutions in a variety of fields.

This brief’s findings will support

the healthcare field. In addition,

related entities including

nonprofit organizations can use

the information presented in the

course of their operations, such as

for grant writing. However, the

knowledge can also inform other

undertakings such as economic

development in prioritizing

geographic development needs.

With targeted, improved job

opportunities, Kansans could earn

higher incomes, secure insurance

coverage and, thereby, be able to

access care.

More Information

Future HPRSolutions Briefs

This brief lays the groundwork for a subsequent brief that will look more closely at Kansans most likely to be eligible for the new Medicaid program in 2014. By county, this upcoming brief will give the numbers and percentages of this population without insurance and make projections of those newly eligible for Medicaid in 2014. Subsequent briefs will continue the thread. One will make projections of persons eligible for subsidies (e.g., premium tax credits to purchase policies through the Exchange and cost-sharing subsidies to limit out-of-pocket costs) and where they may be living in 2014. Others will hone in on ACA projections for children and provisions for older adults.

About HPRSolutions

Health Policy and Research Solutions is a Limited Liability Company that provides independent findings about a variety of health-related topics to inform policy and practice. HPR functions in collaboration with our Advisory Panel. HPR Advisors generously contribute their expertise from the richness of their diverse experiences and affiliations. HPR products are carefully scrutinized through a rigorous review process. Please visit our website at http://hprsolutionsllc.com to learn more about our group.

Copyright© Health Policy and Research Solutions March 2012. HPR publications and methodologies are copyrighted with all rights reserved. Our works may be reprinted with written permission. Please contact us for suggested citations for referencing or quoting work.

_____________________________________________________________________________________________ http://hprsolutionsllc.com - 4 - Population Brief 3.3/March 2012

Chautauqua Cherokee

Labette

Comanche Harper

Seward

Stevens Morton

Barber Clark Meade Sumner Cowley

Elk

Crawford

Neosho Wilson Kingman Kiowa Haskell Grant Stanton Pratt

Sedgwick Ford Gray

Bourbon Allen

Woodson

Edwards Butler

Reno

Greenwood

Harvey Hodgeman

Stafford Hamilton

Finney

Kearny

Pawnee Linn Anderson Coffey

Rice Chase

Marion McPherson

Rush Barton Ness

Wichita

Greeley

Lane Scott

Miami Franklin

Lyon

Osage Ellsworth Morris

Saline Johnson

Douglas Trego Russell

Dickinson

Gove Ellis Wallace

Logan

Wyandotte

Wabaunsee

Shawnee Lincoln

Geary

Ottawa

Leavenworth Jefferson

Pottawatomie Riley

Graham Mitchell Clay Sheridan Osborne

Thomas Sherman Rooks

Atchison

Jackson

Cloud

Nemaha Brown Marshall

Phillips Norton

Decatur Washington Republic Smith

Jewell Rawlins Cheyenne

Map 1: Percentages of Kansans Under 65 Earning Incomes at or Below 138% FPL

17%

17.4%

17.6%

18.3%

14.9%

14.8%

15.2%

9%

8.2%

16.9%

15.8%

18.8%

18.9%

19%

19.2%

19.3%

19.4%

19.5%

22%

22.1%

19.7%

19.8%

20%

20%

20.4%

20.4%

20.5%

20.6%

20.7%

20.8%

20.9%

21.4%

21%

21%

21%

21.2% 21.4%

21.4%

21.5%

21.6%

21.7%

21.3%

21.8%

21.8%

22.1%

22.4%

22.5%

22.7%

22.8%

23%

22.2%

22.3%

22.6% 23%

23.1%

23.1%

23.1%

23.1%

23.6%

26%

23.2%

23.2% 23.4%

23.4%

23.7%

23.7%

23.8%

24.1%

25% 24.2%

24.2%

24.4%

24.5%

24.8%

24.9%

25%

25%

25.1%

25.2%

25.5%

25.6%

25.7%

26.1%

26.3%

26.6%

26.7%

26.9% 27%

27%

27.1%

27.2%

27.6%

28%

28.4%

28.6%

28.7%

29.3%

31.4%

33%

29.8%

30.1%

30.9%

32.7%

33%

47.2%

20 to 21.9% 8.2 to 19.9%

State Percent = 20.4%

22 to 23.6% 23.7 to 26.4% 26.5 to 47.2%

Source: U.S. Census Bureau, Small Area Health Insurance Estimates (2009)

Health Policy and Research Solutions/March 2012 http://hprsolutionsllc.com

Page intentionally left blank

Chautauqua Cherokee Labette

Comanche Harper

Seward

Stevens Morton Barber Clark Meade Sumner Cowley

Elk Crawford

Neosho Wilson Kingman Kiowa Haskell Grant Stanton Pratt

Sedgwick Ford Gray

Bourbon Allen Woodson

Edwards Butler

Reno

Greenwood

Harvey Hodgeman

Stafford Hamilton

Finney

Kearny

Pawnee Linn Anderson Coffey

Rice Chase

Marion McPherson

Rush Barton Ness

Wichita

Greeley

Lane Scott

Miami Franklin

Lyon

Osage Ellsworth Morris

Saline Johnson

Douglas Trego Russell

Dickinson

Gove Ellis Wallace Logan

Wyandotte

Wabaunsee

Shawnee Lincoln

Geary

Ottawa

Leavenworth Jefferson

Pottawatomie Riley

Graham Mitchell Clay Sheridan Osborne

Thomas Sherman Rooks

Atchison

Jackson

Cloud

Nemaha Brown Marshall

Phillips Norton

Decatur Washington Republic Smith

Jewell Rawlins Cheyenne

Map 2. Numbers of Kansans Under Age 65 Earning Incomes at or Below 138% FPL

166

1,606

984

3,124

3,990

9,665

8,280

42,581

1,916

341

2,394

257

1,306

1,135

3,751

930

714

5,416

852

551

1,527

975

2,653

1,480

1,232

287

4,751

316

359

88,017

2,343

1,098

1,023

3,222

766

467 417

399

349

396

9,832

1,372

1,356

4,896

32,700

804

411

961

531

927

1,531

1,020

772 977

3,129

5,194

1,200

1,013

12,140

633

811

404 627

23,984

518

1,790

861

1,948

798 585

1,204

416

431

7,001

516

1,100

1,776

1,573

488

722

2,050

572

3,399

7,233

1.235

1,385

2,835 653

7,641

299

2,039

770

608

5,055

10,917

4,975

8,700

6,493

740

3,599

19,200

9,994

43,929

9,174

3,676

166 to 551 552 to 975

State Number = 488,159

976 to 1,606 1,607 to 4,975 4,976 to 88,017

Source: U.S. Census Bureau, Small Area Health Insurance Estimates (2009)

Health Policy and Research Solutions/March 2012 http://hprsolutionsllc.com