More About January Angeles

January Angeles

January Angeles is a Policy Analyst at the Center on Budget and Policy Priorities, focusing on Medicaid and state health policy issues.

Full bio and recent public appearances | Research archive at

The Tax Rules That Health Care Assisters Need to Know

July 31, 2014 at 4:39 pm

“Navigators” and others helping people apply for health coverage need to understand basic tax filing rules because eligibility for Medicaid, the Children’s Health Insurance Program (CHIP), and premium tax credits for coverage bought through federal and state Marketplaces is based on Internal Revenue Code definitions of income and household.  We’ve developed The Health Care Assister’s Guide to Tax Rules to help fill this need.

The guide provides basic information on relevant tax rules, including when someone is required to file taxes, what filing status options are available, the rules for claiming someone as a tax dependent, and what sources of income are taxable and therefore counted in determining eligibility for Medicaid, CHIP, and premium tax credits.  It also shows how Medicaid uses an individual’s tax filing status to determine who is in his or her household, and how Medicaid’s household rules differ from those used for premium tax credits.

Understanding these issues can help health care assisters work with applicants for health coverage, especially those who have complicated family situations or unpredictable sources of income or are not familiar with filing taxes.

President’s Budget Reaffirms Federal Commitment to Pay for Nearly All of Medicaid Expansion

March 13, 2014 at 11:15 am

As policymakers in a number of states debate whether to adopt health reform’s Medicaid expansion, opponents continue to claim that the federal government, in the name of deficit reduction, will inevitably renege on its commitment to fund nearly all of the cost and instead shift large costs to states.  As Florida state senator Jeff Brandes put it recently, “Why in the world would we take the federal government’s . . . promise that they’ll pay for [the] Medicaid expansion when we know that they will be unable to keep that promise in the long run?”

But, there’s no evidence to support that argument, as we’ve pointed out (see here and here).

The Obama Administration has repeatedly said that it will oppose any cost-shifts that would make states less likely to take up the Medicaid expansion.  And, the President’s new budget reaffirms yet again that the federal government will pick up nearly all of the expansion’s costs:  100 percent for the first three years (2014-2016) and no less than 90 percent on a permanent basis.

Like last year’s budget, the President’s budget has no Medicaid proposals that produce federal savings by shifting costs to states.  It instead proposes to achieve some Medicaid savings by lowering the program’s prescription drug costs.

Moreover, as we’ve pointed out, pressures to cut Medicaid and shift costs to states in order to reduce the federal deficit have dissipated.  In fact, the only federal lawmakers now pushing to shift Medicaid costs to states are not health reform proponents but instead those who oppose health reform and who would convert Medicaid to a block grant or set a per capita cap on federal Medicaid funding.

More Evidence That Medicaid Expansion Makes Fiscal Sense for States

January 29, 2014 at 4:32 pm

Armed with new data, Virginia’s Medicaid agency estimates that adopting health reform’s Medicaid expansion — which it originally estimated would cost the state $137 million through 2022 — would actually save the state more than $1 billion over that period.  That echoes what we’ve said all along:  expanding Medicaid is a good deal for states.

Opponents of the Medicaid expansion have often cited flawed studies that exaggerate its cost to states, such as by assuming that newly eligible Medicaid enrollees would be much sicker (and thus more expensive to cover) than current enrollees.  Analysis shows the opposite is true: non-disabled adults who newly enroll into Medicaid are more likely to be healthier than those who are already enrolled.

Virginia’s Department of Medical Assistance Services (DMAS) now agrees.  Looking at new data and other states’ experience with recent Medicaid expansions, DMAS found that uninsured adults who newly enroll into Medicaid would likely have the same, if not lower, costs than currently enrolled adults.

DMAS also significantly raised the estimate of how many uninsured people would newly qualify for Medicaid under an expansion.  This means Virginia would have to spend even less to reimburse hospitals for uncompensated care for the uninsured than under the earlier estimate, since more of the uninsured would have Medicaid.  And, the drop in Virginia’s uncompensated care costs through 2022 would more than offset Virginia’s cost of covering newly eligible Medicaid beneficiaries over that period (in part because the federal government will reimburse 100 percent of the cost of covering these new enrollees through 2016), producing a net saving for the state.

States that have not expanded Medicaid can’t keep ignoring the fact that expanding Medicaid has significant benefits for states.

Medicaid Expansion Would Not Collapse Private Insurance

April 24, 2013 at 4:53 pm

Louisiana Governor Bobby Jindal’s recent claims that expanding Medicaid will force people out of private coverage and into government health care are overblown.  The reality is this:  an overwhelming majority of people who would get coverage under a Medicaid expansion are low-income people who are uninsured, and they generally can’t afford private health care to begin with.

As we’ve noted before, states that expanded Medicaid in the past by raising income eligibility levels for adults reduced the ranks of the uninsured without undermining private coverage.  That’s based on an analysis of Census data and consistent with an extensive body of research.  In states that expanded Medicaid, about the same proportion of Medicaid-eligible adults had private coverage as in states that didn’t expand, but the expansion states had a much lower proportion of uninsured low-income residents.

Governor Jindal fails to recognize that many people who would qualify for an expanded Medicaid program under health reform work in low-wage jobs for small firms or service industries that typically don’t offer health insurance benefits.  In addition, coverage in the individual insurance market is unaffordable for most of those who would be eligible for the Medicaid expansion.  My colleague, Jesse Cross-Call, recently pointed out that:

  • 81 percent of workers earning less than 138 percent of the poverty line — the threshold for qualifying for Medicaid under health reform — don’t get coverage through their employer.
  • The median annual cost of single coverage in the individual market, including premiums and out-of-pocket costs, would consume more than one-third of the total income of a family of three at the poverty line.

The bottom line:  expanding Medicaid will not lead to low-income people dropping out of employer-based coverage.  But failure to expand would force them to remain uninsured and forego care.

Ryan Budget, Not Medicaid, Creates a Two-Tiered Health Care System

April 5, 2013 at 11:33 am

Medicaid beneficiaries have very good access to quality health care, despite claims to the contrary that House Budget Committee Chairman Paul Ryan has made to justify his proposal to convert Medicaid to a block grant.

As we’ve explained, Chairman Ryan’s budget plan would slash federal Medicaid spending and add millions to the ranks of the uninsured and underinsured.  It also rests on a flawed perception of the program.  Ryan claims that Medicaid provides poor quality care and that beneficiaries often can’t find a doctor who accepts Medicaid, thus creating a two-tiered health care system for low-income individuals and families.

A large body of research, however, has consistently demonstrated the reverse.

  • Children on Medicaid and the Children’s Health Insurance Program (CHIP) have the same level of access to primary care as children with private insurance.  While children on Medicaid and CHIP may face greater barriers to access to specialty care than children with private insurance, they are more likely to have access to such services than uninsured children (see chart).
  • Adults on Medicaid fare as well as privately insured adults on a number of measures of health care access, and they also have greater access to care than uninsured adults.  And despite the fact that Medicaid beneficiaries tend to be sicker and are more likely to have chronic illnesses or disabilities and greater health needs than those using private insurance, their access to care is as good (see chart).

Research also shows that Medicaid improves the overall health and financial well-being of millions of low-income individual and families.  As my colleague, Judy Solomon, has noted, a landmark study of Oregon’s Medicaid program found that people on Medicaid were less likely to experience a decline in health or have unpaid medical bills and financial insecurity than people who did not have insurance.

Ironically, Chairman Ryan’s proposal to convert Medicaid into a block grant could cause his claims about the program’s shortcomings to become a reality.  His plan would cut federal Medicaid funding by 31 percent by 2023 (and by more in later years) relative to current law (not counting the effects of also repealing the Affordable Care Act’s, or ACA’s, Medicaid expansion).

Funding cuts of this magnitude would leave states little choice but to slash already-low provider payment rates — by more than 30 percent, the Urban Institute has estimated — and thus make it far more likely that doctors would be unavailable to serve Medicaid patients.  Moreover, the Urban Institute also projected that a similar block grant proposal in Chairman Ryan’s budget last year would have resulted in states cutting Medicaid enrollment by between 14.3 million and 20.5 million people by 2022.  (This is on top of the effects of repealing the ACA’s Medicaid expansion, which would deny access to care to 17 million people who would otherwise gain coverage if all states adopt the expansion).

Millions more low-income Americans would be uninsured, lack access to care, and thus be made worse off under the Ryan budget.  That’s a two-tiered health care system that we should worry about.