The ACA’s Medicaid Eligibility Provisions: Implications for Eligibility Workers August 14, 2012 NEW: PATHS 37 th Annual Training Conference Nashville, Tennessee Cheryl A. Camillo
Medicaid expansion to non-elderly adults with income up to at least 133% FPL (plus 5% disregard)* Other changes so that all non-elderly individuals are covered to at least 133% FPL (plus 5% disregard) Premium tax credit and cost sharing subsidy for individuals/families with income < 250% FPL to purchase coverage through an exchange Premium tax credit for individuals/families with income from 250% - 400% FPL to purchase exchange coverage Optional state-established Basic Health Programs to provide coverage to certain individuals with income < 200% FPL in lieu of exchange coverage *Optional per Supreme Court ruling Insurance Affordability Programs (in 2014) 2
Requires simplified and coordinated eligibility system between all insurance affordability programs –Program information must be on the Web –Single, streamlined application for health insurance must be accepted via the Web, telephone, mail, or in person –States may also use multi-program applications –No wrong door: Medicaid and CHIP agencies and exchanges must, at minimum, seamlessly coordinate eligibility determinations. –Must make electronic transfers or share eligibility system Mandates that eligibility for most individuals be determined using modified adjusted gross income (MAGI) as defined in the Internal Revenue Code –Must use IRS’ methodologies with a few exceptions Eligibility Changes (in 2014) 3
Requires conversion of states’ current net income standards, including disregards, into equivalent MAGI income standards –Must, on aggregate, cover everyone who was eligible in December 2009 Prohibits face-to-face interviews and asset tests for MAGI populations Mandates that states obtain and use reasonably compatible Federal data from shared services/data hub Makes renewal process less burdensome for beneficiaries –Pre-populated renewal forms; 30 days to respond; 90- day grace period for “reenrolling” Eligibility Changes (in 2014) 4
Insurance affordability programs system could better coordinate health insurance enrollment but further Medicaid’s delinking from traditional welfare programs States need to: –Make decisions about exchanges and the Medicaid expansion –Develop regulations, manuals, and other policy guidance –Reengineer processes –Update, enhance, or replace automated eligibility determination systems –Connect to data hub and facilitate data sharing/linking –Implement new outreach strategies –Retrain, and potentially reorganize, eligibility workers Implications 5
Released proposed (August 17, 2011) and final/interim final (March 23, 2012) rules; held six webinars on final rule Formed State Operations and Technical Assistance teams Held conference calls/QA sessions with states re: MAGI; released MAGI conversion white paper for comment Released proposed data element set for application Providing enhanced funding and other support for eligibility system modernization Developing MACPro system for state policy submittals Selected CMS Implementation Activities 6
Establishment of health insurance exchanges (16 states) Seeking eligibility systems upgrades (29 states) Expanding to adults early (8 states) Requesting policy guidance from CMS Conducting research about 2014 enrollment Developing straw models, flow diagrams and other implementation aids Selected State Implementation Activities 7
Coordinating Human Services Programs with Health Reform Implementation: A Toolkit for State Agencies (Center on Budget and Policy Priorities) 2014 Medicaid Eligibility Transition Toolkit (State Health Reform Assistance Network) Focus groups/message testing with low-income residents (Lake Research Partners and GMMB) Work Support Strategies: Streamlining Access and Strengthening Families (Urban Institute/Ford Foundation) Selected Support Activities 8
Questions? Comments? Discussion 9
Please contact: –Cheryl Camillo (202) For More Information 10