New Jersey Medicaid expansion was small, given already large program, Christie says

In a victory lap following his landslide re-election Nov. 5, New Jersey Gov. Chris Christie, a Republican, hit four of the five major Sunday morning talk shows.

On ABC’s This Week, host George Stephanopoulos talked about 2016 Republican primary prospects with Christie. Stephanopoulos flagged Medicaid as a potential source of criticism from Christie’s own party.

"You didn't set up an exchange, but you did accept the expansion of Medicaid under Obamacare," Stephanopoulos said. "And some of your potential rivals like Ted Cruz are going to come after you on that. What's your answer?"

Christie’s response was in line with his standard "Jersey-first" approach to discussions of national politics.

"I do what's best for the people in the state of New Jersey every day," he said. "And expanding Medicaid in the state of New Jersey, given how expansive our program already was, it was a relatively small expansion. But it's going to mean a lot. And it's also going to benefit New Jersey's budget."

We wondered if Christie was right in saying that New Jersey only needed a minor Medicaid expansion to comply with Obamacare. (Christie’s office did not respond to an inquiry for this story, but we did hear from the New Jersey Department of Human Services.)

What the law says

First, some background on the law. The Affordable Care Act expands the pool of individuals who could be eligible to receive Medicaid, a health insurance program for low-income U.S. residents.

Previously, most of the people who were eligible were pregnant women, parents and children in low-income households. The law expands coverage to people 65 and under who have income up to 138 percent of the federal poverty level. This year, the poverty level is $11,490 for an individual.

Each state can individually decide whether or not to participate in this expansion, which the federal government will fully fund for the first three years.

How does New Jersey stack up?

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To evaluate Christie’s claim, we sized up New Jersey’s Medicaid program against those of other states.

Leighton Ku, a Medicaid expert and professor at George Washington University, said it’s not enough to look at a list of how much money each state appropriates for Medicaid funding, because most of the money states appropriate go toward plans for the elderly and disabled -- groups for which Obamacare isn’t expanding Medicaid.

New Jersey now covers parents with incomes up to 200 percent of the poverty level and childless adults at up to 23 percent of the poverty level, according to table 3 of the Kaiser Family Foundation report. Under Obamacare in 2014, that would expand to cover childless adults up to 138 percent of the poverty level.

New Jersey’s current Medicaid coverage puts it among the most generous states for Medicaid. For coverage of parents, Minnesota comes in first nationally at 215 percent of poverty, with New Jersey and two other states just behind. For childless adults, only 17 states offer any eligibility at all, so New Jersey’s 23 percent isn’t as restrictive, relatively speaking, as it might seem.

A 2011 Rutgers University study estimates that 100,000 more New Jersey residents will be eligible for Medicaid in 2014, which currently covers about 1.3 million people. That’s about a 7.7 percent increase in people eligible.

How does that compare to other states? We don’t yet have access to uniform, comprehensive, state-by-state data for the number of people who could benefit from Medicaid eligibility expansions, said Chris Lee, a Kaiser Family Foundation spokesman.

In all, 24 states (plus the District of Columbia) chose to expand Medicaid. However, we could only locate data for nine other states.

For these nine states, we divided the potential increase by the number of people already enrolled in Medicaid. This is an imperfect calculation, because the most recent numbers Kaiser provides are from fiscal year 2010. But it gives a rough sense of the scale.

Of the nine states, only Minnesota had a lower projected eligibility increase than New Jersey (3.7 percent). The other eight had a higher percentage. And, of course, many states aren’t expanding eligibility at all.

Our ruling

Christie touted New Jersey’s "expansive" Medicaid program. Because New Jersey was already generous in its Medicaid eligibility guidelines compared to other states, the potential increase in Medicaid enrollments due to Obamacare is relatively small. Only one out of the other nine states for which we found data had a lower percentage increase in the Medicaid-eligible population due to Obamacare. So Christie’s comment appears accurate, though the uncertainty due to the missing data leads us to rate it Mostly True.

Correction, Nov. 18, 2013: This report was corrected to note that New Jersey's current Medicaid coverage is 23 percent, and that would expand under Obamacare in 2014 to up to 138 percent of the poverty level.  The rating is unchanged. Also, this item was updated shortly after publication to make clear that the New Jersey Department of Human Services did respond to our inquiry.