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Many States Are Making Wide-Ranging Improvements To Medicaid Eligibility and Enrollment Systems to Prepare for the Affordable Care Act in 2014

New Survey Finds States Investing in Technology, Simplifying Enrollment Processes

Washington, D.C. - Nearly all states are pressing forward with information technology and process improvements to develop faster, streamlined Medicaid enrollment systems as required under the Affordable Care Act (ACA) whether or not the state elects to expand Medicaid coverage under the law, according to a report released today by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.

The 12th annual 50-state survey of Medicaid and Children’s Health Insurance Program (CHIP) eligibility, enrollment, and cost-sharing policies was conducted with the Georgetown University Center for Children and Families. As of Jan. 1, 2013, 47 states have applied for or received increased federal funds to make major upgrades to Medicaid enrollment systems, and 42 states have already begun their system development work. Federal regulations released last year outline the requirements for all Medicaid programs to have web-based, paperless, real-time enrollment processes that will rely on electronic data and minimize administrative burdens on individuals and eligibility workers.

“Important changes are coming to all state Medicaid programs,” said Diane Rowland, Executive Vice President of the Foundation and Executive Director of the KCMU. “Our survey shows that states already are making significant advances to modernize the Medicaid enrollment process in 2014 to lower barriers to coverage and reduce administrative burdens for both families and states.”

As states shifted focus to make major system improvements during 2012, a number also continued to make targeted policy and process improvements, often harnessing technology to facilitate families’ access to coverage and gain administrative efficiencies. However, the survey reveals that longstanding gaps in Medicaid coverage for adults persist, highlighting the potential of the Medicaid expansion to increase access to affordable coverage for low-income adults. Key survey findings include:

  • The majority of states are capitalizing on web-based tools and electronic data to facilitate individuals’ access to coverage and ease administrative burdens.
    As of Jan. 1, 2013, 37 states have an online application for Medicaid or CHIP, an increase of four states over last year. Over half of states (28) allow families to renew online, including eight states that added this capability in 2012. And a large majority of states (45) have adopted an electronic data match with the Social Security Administration to verify applicants’ citizenship status, a precursor to the new federal data hub that will be established in 2014 to help states electronically confirm data. While 11 states already have a state hub to access multiple data sources, movement to electronic data verification will represent a major procedural and cultural change in many states.
  • Parents and other adults continue to face significant gaps in Medicaid coverage. In 2012, eligibility levels for children and pregnant women remained stable and strong, as intended by the ACA requirement to maintain coverage. As of Jan. 1. 2013, the median eligibility level is 235 percent of the federal poverty level for children, or $44,861 for a family of three, and 185 percent of the poverty for pregnant women, or $35,316 for a family of three. Adult eligibility continues to fall far short of that for children, and three states (HI, IL, and MN) scaled back coverage for adults during 2012. Parent eligibility remains below poverty in 33 states, and only nine states provide full Medicaid coverage to other adults without dependent children. The ACA Medicaid expansion to 138 percent of the federal poverty level ($26,344 for a family of three) would significantly increase eligibility for parents in many states, with even larger potential gains for other adults. If a state does not expand Medicaid, poor adults who are uninsured will not gain access to a new affordable overage option and likely remain uninsured.
  • During 2012, a majority of states did not impose additional cost-sharing requirements on families even though they continued to experience budget constraints. States generally cannot increase premiums under current federal requirements to maintain eligibility and enrollment policies until 2014. As such, premium changes were minimal. However, states are not restricted from increasing co-payments within federal program limits, and nine made such increases in 2012.

The 50-state survey report was released today at a public briefing at the Foundation’s Washington offices and can be found online. Also released was Faces of the Medicaid Expansion: How Obtaining Medicaid Coverage Impacts Low-Income Adults, which highlights the experiences of previously uninsured adults who recently obtained Medicaid coverage in several states that already expanded coverage to adults in advance of 2014. To provide greater insight into the impacts of expanding Medicaid, it examines how gaining coverage affected individuals’ health, finances, employment, and overall well-being.

The Kaiser Family Foundation, a leader in health policy analysis, health journalism and communication, is dedicated to filling the need for trusted, independent information on the major health issues facing our nation and its people. The Foundation is a non-profit private operating foundation, based in Menlo Park, California.

The Kaiser Commission on Medicaid and the Uninsured provides information and analysis on health care coverage and access for the low-income population, with a special focus on Medicaid’s role and coverage of the uninsured. Begun in 1991 and based in the Kaiser Family Foundation’s Washington, D.C. office, the Commission is the largest operating program of the Foundation. The Commission’s work is conducted by Foundation staff under the guidance of a bipartisan group of national leaders and experts in health care and public policy.