This brief examines Medicaid’s medically needy program, which gives states the option to extend Medicaid eligibility to those with high medical expenses whose income exceeds the maximum threshold, but who would otherwise qualify. It provides updated enrollment and spending figures on the medically needy using data through federal fiscal year…
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Executive Summary One of the key goals of the Affordable Care Act (ACA) is to reduce the number of uninsured through a Medicaid expansion and the creation of health insurance exchange marketplaces with advance premium tax credits to help moderate-income individuals pay for this coverage. Given that people of color…
Medicaid Eligibility, Enrollment Simplification, and Coordination under the Affordable Care Act: A Summary of CMS’s March 23, 2012 Final Rule
This brief provides a summary of the Centers for Medicare and Medicaid Services’ (CMS) March 23, 2012 final rule to implement the ACA provisions relating to Medicaid eligibility, enrollment simplification and coordination. The rule, which is effective Jan. 1, 2014, lays out procedures for states to implement the Medicaid expansion…
Getting into Gear for 2014: Findings From a 50-State Survey of Eligibility, Enrollment, Renewal and Cost-Sharing Policies in Medicaid and CHIP, 2012-2013
This 50-state survey provides a snapshot of Medicaid and CHIP enrollment and eligibility policies and procedures and highlights the changes that states will need to make in their programs to prepare for the ACA in 2014.
This report discusses key responsibilities that the federal government and states hold for managing the Medicaid program and identifies the key issues and challenges states face as they transform the way they do business and achieve key national goals. The paper relies on an extensive review of federal and state administrative responsibilities drawn from statute, regulation, and relevant literature, coupled with discussions with six current Medicaid directors.
Regardless of state Medicaid expansion decisions, all states must implement new eligibility and enrollment processes, including a transition to determine income eligibility for most groups based on Modified Adjusted Gross Income (MAGI). As part of the transition to MAGI, states’ existing Medicaid income limits for children, pregnant women, parents, and childless adults will be converted to MAGI-equivalent limits. This fact sheet provides Medicaid income limits for parents and childless adults as of January 2013, and the new income limits that will be in effect as of January 1, 2014.
Medicaid in a Historic Time of Transformation: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2013 and 2014
The report findings are drawn from the 13th annual budget survey of Medicaid officials in all 50 states and the District of Columbia. The report highlights trends in Medicaid spending, enrollment and policy initiatives for FY 2013 and FY 2014 with an intense focus on eligibility and enrollment changes tied to the implementation of the ACA as well as payment and delivery system changes. The report provides detailed appendices with state-by-state information and a more in-depth look at four case study states: Arizona, Florida, Kentucky and Washington.
The expansion of Medicaid eligibility under the Affordable Care Act (ACA) fills in historical gaps in coverage for adults and is a key piece of the continuum of new coverage options. However, in states that do not expand Medicaid, nearly five million poor uninsured adults have incomes above Medicaid eligibility levels but below poverty and may fall into a “coverage gap” of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits.
This issue brief details the various eligibility pathways by which individuals with disabilities and the elderly can qualify for Medicaid coverage. The program, which serves as a safety net for many of the nation’s poorest and sickest individuals, provides health coverage to nearly 60 million Americans, including 8.5 million with…
As states wrap up legislative sessions and make decisions about whether to implement the Medicaid expansion included in the Affordable Care Act (ACA), this new analysis highlights the implications of these decisions for coverage, state budgets and providers. The decisions by as many as 27 states not to adopt the Medicaid expansion will leave a many more uninsured; these states would also forgo billions in federal funds.