Under the Affordable Care Act, Medicaid expansion and non-expansion states alike have implemented streamlined Medicaid enrollment systems that facilitate real-time eligibility determinations and automated renewals, according to a new 50-state survey from the Kaiser Family Foundation.

Before the ACA, individuals could not apply for Medicaid by phone or online in many states. They typically had to provide paper documentation like pay stubs and wait weeks for an eligibility determination – and do it all over again at renewal. In 2018, 50 states take online applications (up from 36 in 2013), 49 allow phone applications (up from 17) and 46 have automated renewal (up from 22), finds KFF’s 16th annual survey of Medicaid and CHIP eligibility, enrollment, renewal and cost sharing policies.

Individuals in most states now can receive a real-time eligibility determination in less than 24 hours without having to submit pay stubs when the state is able to verify information through electronic data matches with trusted data sources. Looking ahead, recent approved and proposed Section 1115 waivers in some states seeking to implement work requirements, premiums and cost sharing and lockout periods in Medicaid would require new documentation and costly administrative processes that could add new administrative complexity in affected states.

The new survey provides comprehensive data on Medicaid and CHIP eligibility, enrollment, renewal, premium, and cost sharing policies for each state as of January 2018. It also discusses policy changes during 2017 and looks ahead to emerging issues for states. Other key survey findings include:

• Medicaid and CHIP continue to provide a robust base of coverage for low-income children and pregnant women. Nearly all states cover children with incomes up to at least 200% of the federal poverty level ($41,560 per year for a family of three in 2018), including 19 states that cover children with incomes at or above 300% FPL ($62,340 per year for a family of three). Since implementing the ACA, states have continued to take up targeted options to expand Medicaid and CHIP coverage that focus on children and pregnant women.
• There have been major gains in Medicaid eligibility for parents and other adults in the 32 states that have expanded Medicaid under the ACA. Gaps in coverage remain for poor adults in non-expansion states, where the median eligibility limit for parents is 43% FPL (about $9,000 per year for a family of three ) and other adults generally are ineligible regardless of income.

The full report, Medicaid and CHIP Eligibility, Enrollment, Renewal and Cost Sharing Policies as of January 2018: Findings from a 50-State Survey, includes detailed tables with state-by-state data in the appendix. Also available at kff.org is a recently released companion analysis, Implications of Emerging Waivers on Streamlined Medicaid Enrollment and Renewal Processes.