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Fast Track to Coverage: Facilitating Enrollment of Eligible People into the Medicaid Expansion

Fast Track to Coverage: Facilitating Enrollment of Eligible People into the Medicaid Expansion – Introduction
  1. The Affordable Care Act requires states to apply a 5 percentage point of the FPL disregard to the new adult group, effectively increasing the income threshold for the Medicaid expansion from 133% to 138% of the federal poverty level (FPL).

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  2. Arkansas is using a premium assistance model for its coverage expansion.  Under the model, known as the “private option” within the state, Arkansas is using Medicaid funds to enroll newly eligible adults into Qualified Health Plans (QHPs) offered through its new Marketplace.

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Fast Track to Coverage: Facilitating Enrollment of Eligible People into the Medicaid Expansion – Issue Brief
  1. State Health Official Letter.  Centers for Medicare & Medicaid Services.  May 2013.  Available at: http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-13-003.pdf.

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  2. Other options included in the May 2013 letter, but not discussed in this paper include: 1) implementing the early adoption of Modified Adjusted Gross Income (MAGI), 2) extending Medicaid renewals scheduled to take place during the first calendar year of 2014, and 3) adopting 12-month continuous eligibility for parents and other adults.

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  3. Under Express Lane, an option established by the Children’s Health Insurance Program Reauthorization Act, states may use information from programs such as SNAP, Temporary Assistance for Needy Families (TANF), Head Start, and Women, Infants, and Children (WIC) to identify children who meet Medicaid criteria so that families do not have to resubmit the same information to multiple programs. As with the new fast track enrollment option, states still must verify citizenship and immigration status in accordance with Medicaid standards.  Similarly, after the Medicare Modernization Act established the Medicare Part D benefit and an accompanying low-income subsidy program, the Department of Health and Human Services elected to deem “partial benefit” Medicaid beneficiaries as eligible for the low-income subsidy program. While the eligibility rules for the low-income subsidy differ from those used in Medicaid, HHS determined that it would be administratively efficient to simply deem these individuals as automatically eligible for the low-income subsidy.

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  4. According to HHS's May 17th letter, "Recent studies by both the Center on Budget and Policy Priorities and the Urban Institute find that, despite the differences in household composition and income-counting rules, the vast majority of non-elderly, non-disabled individuals who receive SNAP benefits are very likely also to be financially eligible for Medicaid.”

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  5. Martha Heberlein, et. al. “Medicaid Coverage for Parents under the Affordable Care Act.” Georgetown University Health Policy Institute Center on Children and Families, June 2012. Available at: http://ccf.georgetown.edu/wp-content/uploads/2012/08/Medicaid-Coverage-for-Parents.pdf.

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  6. Under the ACA, financial eligibility determinations for Medicaid, CHIP, and premium tax credits and cost sharing reductions for Marketplace coverage will be based on Modified Adjusted Gross Income (MAGI). MAGI is based on IRS definitions of what counts as income after selected deductions are taken into account.

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  7. States are required to comply with Medicaid citizenship verification requirements when processing fast track applications.  As a result, states must re-verify the citizenship status of fast track applicants using Medicaid (rather than SNAP) procedures.  In addition, those states (Oregon and West Virginia) that are enrolling the parents of Medicaid children in coverage must verify their citizenship or immigration status in accordance with Medicaid requirements.

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  8. The federal data services hub connects states to common federal data sources (including but not limited to Social Security Administration, Internal Revenue Service, and Department of Homeland Security) to verify consumer application information for income, citizenship, and immigration status.

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  9. Fast Track to Oregon Health Plan Materials are available at: http://www.oregon.gov/oha/healthplan/pages/fast-track.aspx.

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