Medicaid Eligibility Expansion Varies By State

Because some states have not yet expanded Medicaid, about 2.2 million people are in whats known as a coverage gap: They have no realistic access to health insurance, strictly based on the fact that they live in a state that hasnt accepted federal funds to expand Medicaid.

As of 2022, there are a dozen states that have not expanded Medicaid, and a coverage gap exists in 11 of them .

Why Are Californians Required By Law To Have Health Insurance

What you need to know about the individual mandate â and how it impacts you and your family.

Having health insurance isnât just a good idea â if you live in California, itâs the law. In fact, 2020 marked the first year that Californians are required by state law to have health insurance. This law is referred to as the individual mandate because it means that all individuals in California are mandated to be covered by health insurance. Hereâs what you need to know to understand the individual mandate and how this law can benefit you.

Understanding Health Care Reform

The Patient Protection and Affordable Care Act passed in 2010 with the mission of making quality health care more accessible and affordable nationwide. There were two key points of this act. First, people could no longer be denied or charged more for health insurance due to preexisting conditions. Second, a federal individual mandate was established, which meant that having health insurance that meets specific conditions was a requirement under law. These two aspects worked hand in hand. By making sure everyone paid into the system â young and old, healthy and ill â the sickest members could receive care without premium costs going haywire for everyone. Since the individual mandate went into effect, those who chose to go uninsured faced a financial penalty at tax time.

The Individual Mandate Comes to California

More Financial Help for Californians

What Does This All Mean for Me?

Exemptions For Unaffordable Coverage Through Mnsure

You can claim this exemption based on coverage being unaffordable for the months in 2018 when you did not have coverage when you fill out your 2018 tax return, which was due in 2019.

You can claim this exemption using the federal Form 8965. You will need to use the following information from MNsure to complete this form:

• The premium amount for the lowest cost 2018 bronze plan that would have covered all members of your household seeking an exemption and
• The premium amount for the second-lowest cost 2018 silver plan that would have covered all members of your household seeking an exemption.

This information is easy to find using the instructions below.

NOTE: If you are applying for an exemption for unaffordable coverage from your employer, you do not need any information from MNsure. You will need to follow the directions on the federal exemption application to submit information about your employer’s plan. You can claim this exemption when you file your taxes using the federal Form 8965.

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Why You May Still Need Health Insurance

There are many reasons why its important to maintain health insurance. A comprehensive health insurance plan can cover most or all medical and hospital expenses if youre injured, sick or require an operation. It can also offset costs for preventative care like screenings, check-ups and vaccines that are essential for maintaining your health long-term.

A comprehensive health insurance plan can protect you from shouldering thousands of dollars in fees and potential debt. Some types of health insurance pay qualifying costs upfront others will offer you reimbursement. Either way, youre saving a significant amount of money in the event of an expensive emergency, accident or unexpected diagnosis.

Knowing that you or your loved ones wont go bankrupt from receiving the care you may, quite literally, need to survive is a peace of mind only having a good health insurance plan can bring.

Waiting Periods To Become Eligible For Coverage

Employers may not impose enrollment waiting periods that exceed 90 days for all plans beginning on or after January 1, 2014. Shorter waiting periods are allowed. Coverage must begin no later than the 91st day after the hire date. All calendar days, including weekends and holidays, are counted in determining the 90-day period.

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Mental Health In State’s Health Education Curriculum

This new law says that Illinois’ “Comprehensive Health Education Program” must include information and education about how and where to find mental health resources and specialized treatment in the state.

The bill also creates a mental health council that works to figure out how to help students find a mental health provider, how to access the mental health system, and puts lessons and teachings about mental health into school curriculums.

Rhode Island Individual Mandate Guide

History of legislation

The State of Rhode Islands individual mandate, requiring residents to have qualifying coverage throughout the year, goes into effect on January 1, 2020. It was signed into law on July 5, 2019. Rhode Island issued proposed regulations outlining the employer reporting obligation.

Important dates

Employers are required to report annually by March 31, 2023. The employee mail form deadline is March 2, 2023.

Employer obligations

Employers must submit a report of covered individuals to the state, where a flat file version of the 1095-B is used.

Rhode Island individual mandate penalties

Process for filing

A flat file format, , of the 1095-B is loaded directly into the Rhode Island site. A real-time confirmation is shown on the webpage once the file is successfully uploaded.

A correction file can be sent any time after the original submission, in the same format, by uploading into the RI site. If the resubmission occurs after December 31st in the year in which it is due, the Rhode Island requests that they be contacted by email at [email protected] with the subject line Individual Mandate.

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How Do I Enroll In A Health Insurance Plan During Open Enrollment

You can enroll in a health insurance plan online, over the phone, or in person. To enroll, you will need the following information:

• Name, address, email address, social security number, birthday, and proof of citizenship status
• Household size and income if you want to apply for subsidies
• Coverage details and premium for an employer-sponsored plan thatâs available to anyone in your household
• Payment information for your premiums
• Your doctorsâ names and zip codes so that you can check to make sure theyâre in-network
• A list of medications taken by anyone who will be covered under the policy
• If you want to enroll in a catastrophic plan and are 30 or older, youâll need a hardship exemption.

How Many Months Of Health Insurance Do I Need To Avoid A Tax Penalty

There is no longer a federal fine for not having health insurance. In states that require health insurance and have a penalty, including Massachusetts, California, New Jersey, and Rhode Island, the consensus is that you should have at least nine months of health insurance coverage throughout the year. If you lose coverage for one to two months, you will likely not be subject to any penalties, but you do have to make sure to document this gap for your taxes.

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Employer Mandate Coverage Requirements Since 2016

Employers with 50 or more full-time and/or FTE employees must offer affordable/minimum value medical coverage to their full-time employees and their dependents up to the end of the month in which they turn age 26, or they may be subject to penalties. The amount of the penalty depends on whether or not the employer offers coverage to at least 95% of its full-time employees and their dependents.

Employers must treat all employees who average 30 hours a week as full-time employees.

Dependents include children up to age 26, excluding stepchildren and foster children. At least one medical plan option must offer coverage for children through the end of the month in which they reach age 26. Spouses are not considered dependents in the legislation, so employers are not required to offer coverage to spouses.

New Jersey Individual Mandate Guide

History of legislation

The State of New Jerseys individual mandate, requiring residents to have qualifying coverage throughout the year, went into effect on January 1, 2019. It was signed into law on May 30, 2018. The state released reporting requirements in June 2019 and continues to release more information.

Important dates

Employers are required to report annually by the federal deadline . The employee mail form deadline is March 2, 2023.

Employer obligations

In-state and out-of-state employers who employ New Jersey residents, even if the employer does not withhold New Jersey payroll taxes. The reporting obligation is limited to Applicable Large Employers , but requirements differ based on whether the employer offers self-insured or fully-insured coverage.

If an ALE is sending 1095-C forms to employees and filing 1095-C and 1094-C forms with the IRS, they are required to file forms with the state. Employers who only have fully-insured coverage should verify that their insurer will fulfill the reporting requirements for the state. If an ALEs insurer does not meet the obligation to file, the employer is required to file themselves. Likewise, all ALEs who participate in a multi-employer plan should verify reporting with their plan sponsor, or they will be required to file themselves.

New Jersey individual mandate penalties

Process for filing

Frequently asked questions

If you replace or correct files with the IRS, should these files be shared with New Jersey?

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Do You Have To Have Health Insurance

The federal government no longer penalizes you for not having health insurance. But a handful of states have an individual mandate that requires residents to have coverage.

When the Affordable Care Act was passed, one of the key parts of the legislature was the individual shared responsibility provision, known more colloquially as the individual mandate. This provision was the closest the United States came to requiring universal health coverage.

States Banning Or Providing Insurance Coverage Of Abortion Can Determine A Persons Health And Future

• States Banning or Providing Insurance Coverage of Abortion Can Determine a Persons Health and Future

Abortion is an essential part of comprehensive reproductive health care. It is a common medical procedure that one in four women in the United States obtains in her lifetime.1 People in need of abortion must be able to access abortion care when they have made the decision to end a pregnancy. Yet, accessing abortion care can be costly, making insurance coverage critical for people seeking abortion.

Despite the importance of insurance coverage of abortion, state politicians have taken abortion coverage away from people who have decided to have an abortion. Some politicians have passed state laws that prohibit private insurance plans from offering coverage of abortion and other states withhold coverage of abortion from people who are insured through the Medicaid program.

Without affordable coverage of abortion, many people are forced to forgo carethreatening both their physical and economic health. And because of structural racism and other inequities, these laws disproportionately hurt people of color, young people, low-income people, and women.

In contrast, other state governments have taken action to promote the health and economic security of their communities by ensuring that plans provide comprehensive insurance coverage that includes abortion. Every state should do what it can to ensure the best health outcomes for its residents.

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Does Vermont Require Health Insurance Coverage

Vermont’s individual health insurance mandate went into effect on Jan. 1, 2020, requiring most residents 18 and older to acquire acceptable health insurance coverage and report it on their state tax return.

But unlike Massachusetts and Rhode Island, it’s an individual mandate with no teeth. Vermont does not issue financial penalties for non-compliance. Instead, the state messages to the public that “it is important that every Vermonter is covered,” telling residents that health insurance reduces the risk of expensive medical bills helps to cover medications, visits to providers and hospital care and helps people stay healthy by paying for yearly check-ups, screenings and immunizations.

Vermont law requires individuals to report on their state income tax return whether they had health coverage for each month of the year.

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New Smoke Detector Rules

Beginning Jan. 1, the state’s Smoke Detector Act will be changed to state that any smoke detectors must have a “self-contained, non-removable, long term battery.”

The change was approved in 2017, but did not take effect until Jan. 1, 2023.

According to the Illinois Fire Safety Alliance, which worked with the General Assembly to pass the change, it applies to “residents that are still using alarms with removable batteries or alarms that are not hardwired.”

There are a couple of exceptions, however.

According to the bill, the battery requirements do not apply to fire alarms, smoke detectors, smoke alarms, or other components “electronically connected to specified alarm systems,” which use a low-power radio frequency wireless communication signal, Wi-Fi or any other wireless local networking capability.

The change also will not apply to “dwelling units and hotels within municipalities with a population over 1,000,000 inhabitants.”

Smoke alarms in homes built after 1988 that have battery-powered detectors can leave them in until they exceed 10 years from their manufacturing date, unless they fail to respond to tests or malfunction, according to officials.

Those in violation of the law after Jan. 1, 2023 will have 90 days to change their smoke detectors or risk being assessed a fine of up to $100, which can be applied every 30 days until the violation if rectified, up to $1,500.

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Why Have An Individual Mandate

These states have an individual mandate for the same reason the ACA originally did. Without an individual mandate, people would only buy insurance if they knew they were going to need it. Most often, this means the elderly and people with pre-existing conditions.

But those who use their health insurance the most are also the most expensive to insure. Before the Affordable Care Act, insurance companies would evaluate all applicants before enrolling them. Based on peoples age and medical history, the insurance companies would then deny them health care coverage, or charge them more for it. But the ACA made that kind of discrimination illegal. And then it took things one step further. An individual mandate is an incentive for everyone to get health insurance, even healthy people. That meant there was now a larger pool of people applying for health insurance. And with more healthy people getting health insurance, health insurance companies could lower premiums for everyone.

In other words, the individual mandate was meant to be one of the of cost-savings and consumer protections we associate with the ACA. It allows more people to be insured at a lesser rate per person. Even though there is no national individual mandate anymore, some states have passed their own mandates to help keep more people insured at lower costs per person. If the mandates help more people get insured, taxpayers in these states will have lower monthly premiums on average.

Health Insurance Options Vary By State

When it comes to health insurance in the United States, each state has taken its own distinct approach to regulating health policy.

As a result, your health insurance coverage options and access to affordable coverage will vary dramatically depending on where you live.

In the pages of this state health insurance guide, weve provided a detailed look at each states approach to health policy. When you select your state, you can expect to learn about your states:

• approach to providing an ACA marketplace enrollment platform,
• efforts to improve affordability of ACA-compliant coverage,

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Improving Affordability By Stabilizing The Marketplaces

Reinsurance Programs

A strategy that has proven popular among states across the ideological spectrum is reinsurance. Reinsurance programs address rising premiums by partially reimbursing insurers for certain high cost claims, which in turn, enables insurers to lower premiums for all ACA-compliant plans inside and outside the marketplace. Reinsurance programs take different approaches to defining reimbursable claimssome programs pay a portion of claims for consumers with certain medical conditions, while other programs reimburse a percentage of claims between specified dollar amounts. Evidence suggests these programs have been effective at reducing premiums in the individual market. Data from Alaska, Minnesota, and Oregon indicate that the implementation of the reinsurance programs led to lower premium increases than had been expected and prevented insurers from exiting the marketplaces.6 At the same time, while these programs lower premiums overall, they do not address the affordability challenges faced by consumers with moderate incomes, especially older adults, for whom premiums may still be unaffordable even after being lowered by as much as 10-15%.

State Individual Mandate Requirements

State-funded Enhanced Subsidies

Public Plan Option

New Official State Rock

Dolostone has been officially designated as Illinois official state rock after Gov. J.B. Pritzker signed a bill into law in June.

Students from Pleasantdale Middle School in suburban Burr Ridge and Maplebrook Elementary School in Naperville helped to push for the designation.

Dolostone is a sedimentary rock made of the mineral dolomite. It makes up the majority of bedrock in the state of Illinois, and helps provide nutrients to soil, according to geologists.

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District Of Columbia Individual Mandate

Effective: January 1, 2019

State Health Care Services:DC Health Link

Known officially as the Washington D.C. Individual Taxpayer Health Insurance Responsibility Requirement, the mandate requires all residents to have health insurance coverage.

Uninsured residents must pay whatever fine is greater: up to $695 per adult and $347.50 per child, or 2.5% of their family income over the federal tax filing threshold. There is a penalty cap of $3,258 per person for households of more than one person. That means a five-person household has a $16,290 penalty cap.

Exemptions, claimed on your tax return or through DC Health Link, are available.