Healthcare for your Clients in the Era of the Affordable Care Act

Posted: Oct-18-2013. Filed under: Disposition / Mental Health Issues / Role of Counsel / Scope of Representation / Specialization in Juvenile Defense

Medicaid Overview

Medicaid serves as the nation’s primary source of health coverage for the indigent. Each state administers its own Medicaid program, establishes its own eligibility standards, and determines the scope and types of services they will cover (with some new standards created by the ACA). The federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run programs. Medicaid programs are financed jointly between the federal government and states.

Affordable Care Act Overview

The Patient Protection and Affordable Care Act (ACA), enacted in March 2010, aims to improve access to health care in the United States. Some of the most important components of the ACA are new insurance consumer protections, including prohibiting most health plans from imposing lifetime or annual dollar limits on health benefits, denying coverage due to pre-existing conditions, and imposing limits on cost-sharing; providing funding to states to create health insurance exchanges,[1] or mechanisms for people to purchase health insurance; expanding Medicaid eligibility to include most people with very low incomes (but note the U.S. Supreme Court’s ruling that allows states to refuse to expand Medicaid without penalty); and creating subsidies to help low-income individuals purchase insurance. Under the ACA, Americans must obtain coverage (through government insurance or exchanges) or they may be penalized.

What Should Defenders Know?

What Should Defenders or Defender Associations Do?

For more information on the ACA, contact the National Juvenile Defender Center at or
the National Academy for State Health Policy at 202-903-0101 /

* This NJDC factsheet was developed by David Shapiro with generous assistance by Sarabeth Zemel of the National Academy for State Health Policy, November 2013.

[1]In some states, exchanges may be called marketplaces, or may go by another state-specific name.

[2] Patient Protection and Affordable Care Act § 2713 [hereinafter ACA]; What are my Preventive Care Benefits?,, (last visited Oct. 16, 2013).

[3] 42 U.S.C.A. § 1396d(a)(29)(A)42 CFR § 435.1009.

[4] 45 CFR 155.430(b)(2).

[5] Sarabeth Zemel & Neva Kaye, National Academy for State Health Policy, Models for Change, Medicaid Eligibility, Enrollment, and Retention Policies: Findings from a Survey of Juvenile Justice and Medicaid Policies Affecting Children in the Juvenile Justice System 12 (2009).

[6] Letter from Centers for Medicare & Medicaid Svcs. to State Medicaid Directors (May 25, 2004).

[7] Patricia Blair et al., Am. Bar Ass’n, Increasing Access to Health Insurance Coverage for Pre-Trial Detainees and Individuals Transitioning from Correctional Facilities Under the Patient Protection and Affordable Care Act (Feb. 2011).

[8] ACA § 2201(b)(1)(F).