Medicaid Expansions

Recently, HHS and CMS have reported new eligibility and enrollment data for the marketplaces created by the ACA, as well as for Medicaid and CHIP, providing some of the timeliest data on Medicaid enrollment that has ever been captured along with preliminary information on how early ACA implementation is impacting Medicaid enrollment. However, currently, there is no single data source that provides comprehensive information on Medicaid enrollment. As such, to gain a full picture of enrollment in Medicaid, it is important to look across the different enrollment paths connecting people to the program today. This brief provides an overview of these different enrollment paths and national level data available to date on enrollment through these avenues.

The Affordable Care Act (ACA) dramatically expands Medicaid in 2014 in participating states. Meanwhile, six states have already expanded Medicaid since 2010 to some or all of the low-income adults targeted under health reform. The brief took an in-depth look at these six “early-expander” states — California, Connecticut, the District of Columbia, Minnesota, New Jersey, and Washington — through interviews with high-ranking Medicaid officials.

Due to the ACA’s new eligibility verification rules, states have developed plans outlining Medicaid and CHIP eligibility verification procedures. This chart highlights key elements from states’ verification plans, such as which eligibility factors are verified through electronic data and the specific data sources states are using, as well as whether self-attestation is accepted for some eligibility factors. The chart also contains information about how states will determine reasonable compatibility, which is how they will resolve issues if there are discrepancies between electronic data sources and information provided by applicants.

States with Partnership or Federally Facilitated Marketplaces (FFM) are coordinating closely with the federal government on Medicaid eligibility and enrollment. Each state Medicaid agency has chosen whether the Marketplace will only assess, or whether it will also determine Medicaid eligibility for individuals who apply through the Marketplace. This brief outlines the responsibilities of the FFM in assessing or determining Medicaid eligibility, explains the differences between these two models, and examines the rationales behind two states’ choices.

The ACA gives qualified hospitals the opportunity to determine presumptive eligibility (PE) for all Medicaid-eligible populations which will enable hospitals to temporarily enroll individuals in Medicaid, ensuring compensation for hospital-based services, while providing patients access to medical care and a pathway to longer-term Medicaid coverage. This brief, prepared by the Center for Health Care Strategies, provides guidance to aid state Medicaid programs in developing the policies and procedures for hospital PE implementation. It provides valuable insight from the final CMS rule, related CMS guidance, expert sources, and interviews with states currently operating PE programs.