Modern Era Medicaid: Findings from a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP as of January 2015

At the one-year anniversary of implementation of the Affordable Care Act’s (ACA) coverage provisions, states continue work to transform Medicaid and the Children’s Health Insurance Program (CHIP) to realize the ACA’s goals of expanded coverage and a streamlined enrollment system. While many states have worked to enhance access to coverage and simplify Medicaid and CHIP enrollment and renewal processes for a number of years, particularly for children, the ACA has served as a key impetus to accelerate these efforts and move the Medicaid program into a new era to serve as a broad base of coverage for the low-income population and provide a modernized enrollment experience for individuals.

Pivotal action took place in 2014, with the Centers for Medicare and Medicaid Services (CMS) and states working together to implement the ACA’s new eligibility, enrollment, and renewal rules. More than half of the states moved forward with the ACA’s Medicaid expansion to low-income adults, and states made significant headway in adopting the law’s streamlined enrollment and renewal processes. However, implementation remains a work in progress with some states further ahead than others. Looking ahead, many states are now focused on enhancing and improving system functionalities, smoothing out transitions between Medicaid and Marketplace coverage, and progressing to highly-automated renewal procedures.

This report annually surveys Medicaid and CHIP program officials to track eligibility, enrollment, renewal, and premium and cost-sharing policies. Given the fast-paced policy environment leading up to January 1, 2014, when key ACA coverage provisions went into effect, an abbreviated report based on publicly available data was released in November 2013. For this 13^th annual report, we return to conducting interviews with state Medicaid and CHIP officials to gather information on key policies that are in effect as of January 1, 2015.

The report includes information on Medicaid policies for children, pregnant women, parents, and the new adult expansion group, as well as coverage for children and pregnant women under CHIP.¹ Given that state eligibility and enrollment systems and ACA implementation efforts are rapidly evolving, this report provides a point-in-time view, a snapshot. Importantly, it provides a key measure of state Medicaid and CHIP policies in a new era under the ACA. The report is organized into four sections: Medicaid and CHIP Eligibility, Enrollment and Renewal Processes, Eligibility Determination Systems, and Premiums and Cost-Sharing. State-specific information is available in Tables 1 to 19 at the end of the report.