1. Medicaid and CHIP Eligibility and Enrollment in 2014 January Angeles From Vision to Reality: State Strategies for Health Reform Implementation November 11, 2010

2. Coverage expansion up to 133 percent of federal poverty level for adults and children Simplify and upgrade Medicaid eligibility requirements and procedures Coordinate with premium subsidies and participate in no wrong door system Medicaids Major Responsibilities Leading Up to 2014

3. Medicaid Eligibility in 2014 New federal minimum starting in 2014, except for elderly/disabled Note: Figures for parents represent the national median, rather than the federal minimum

4. Effective January 1, 2014 Income eligibility increased to 133 percent of poverty line for all children and non-disabled adults under 65 Enhanced federal matching funds for newly eligible adults Newly eligible individuals must receive benchmark coverage Medicaid Eligibility Expansion

5. No asset test or income disregards Use same rules as premium credits for determining household income - Modified Adjusted Gross Income (MAGI) - Household size based on tax unit Reduce countable income by amount equal to 5 percent of poverty line New Rules for Determining Eligibility

6. Some income now counted will not be counted -Child support received -Social Security benefits Some income not counted will be counted -Step-parent income when determining eligibility for children Impact of New Rules on Medicaid

7. Need to distinguish between MAGI and non- MAGI populations Identifying newly eligible for purposes of: - Match rate - Benefits package Factors Affecting Medicaid Eligibility Process

8. Streamlined system that serves as one-stop shop Single application form Application online, by phone, in person or by mail Minimum documentation standard Establishment of secure, electronic interface to facilitate data exchange Process to screen and enroll Requirements for Coordinating with Premium Credits

9. Despite efforts to align, still key differences in eligibility requirements, including: -Presence of other coverage -Timing of income information -Non-MAGI populations in Medicaid -Household income (?) Challenges of Coordinating Eligibility

10. Unprecedented challenges -Complex new rules -Systems upgrades -Difficult fiscal and political environment But also significant opportunities for real transformation -Leveraging ACA coordination requirements to promote more streamlining in Medicaid and other programs What Lies Ahead?