Medicaid Expansions

This report is the fifth in a series of monthly reports on state Medicaid and Children’s Health Insurance Program (CHIP) data, and represents state Medicaid and CHIP agencies’ eligibility activity for the calendar month of February 2014, which coincides with the fifth month of the initial open enrollment period for the Health Insurance Marketplace. This report includes state data and analysis regarding applications to Medicaid and CHIP agencies and the State Based Marketplaces (SBMs) and eligibility determinations made by the Medicaid and CHIP agencies. New for this month, this report also includes state data on total enrollment in the Medicaid and CHIP programs.

This report is the fourth in a series of monthly reports on state Medicaid and Children’s Health Insurance Program (CHIP) data, and represents state Medicaid and CHIP agencies’ eligibility activity for the calendar month of January 2014, which coincides with the fourth month of the initial open enrollment period for the Health Insurance Marketplace. This report includes state data and analysis regarding applications to Medicaid and CHIP agencies and the State Based Marketplaces (SBMs) and eligibility determinations made by the Medicaid and CHIP agencies.

This final rule establishes the Basic Health Program (BHP), which provides states the flexibility to establish a health benefits coverage program for low-income individuals who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace. The BHP complements and coordinates with enrollment in a QHP through the Exchange, as well as with enrollment in Medicaid and the Children’s Health Insurance Program (CHIP). This final rule also sets forth a framework for BHP eligibility and enrollment, benefits, delivery of health care services, transfer of funds to participating states, and federal oversight.

Beginning in January 2014 all states must implement hospital PE and ensure that hospitals that participate in the Medicaid program can begin making PE determinations to provide temporary Medicaid coverage to individuals who qualify including children, pregnant women, parents, individuals formerly in foster care, and, if applicable in a state, adults covered under the new low-income adult eligibility group. CMS released this set of frequently asked questions for states and stakeholders regarding hospital PA. It discusses questions on the application process, the eligible populations, information on the qualified entities that can make hospital PE determinations, qualification standards for participating hospitals, and the federal matching funds available.

This letter provides guidance to states on how the long-term services and supports-related rules apply to individuals who are eligible for Medicaid under Modified Adjusted Gross Income (MAGI) eligibility rules, and receive coverage for long-term services and supports (LTSS). Some people who need LTSS may qualify for Medicaid under MAGI rules. This guidance is intended to address states’ questions regarding whether the various Medicaid LTSS rules, including the estate recovery rules, will apply to MAGI individuals who are eligible for LTSS coverage.