Medicaid Expansions

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.

The findings in this report are drawn from the 13th annual budget survey of Medicaid officials in all 50 states and the District of Columbia. The report highlights trends in Medicaid spending, enrollment and policy initiatives for FY 2013 and FY 2014 with an intense focus on eligibility and enrollment changes tied to the implementation of the ACA as well as payment and delivery system changes.

One of the significant changes brought about by the Affordable Care Act (ACA) is the introduction of a new methodology to evaluate eligibility for Insurance Affordability Programs (IAPs): Modified Adjusted Gross Income (MAGI). MAGI will be used to evaluate available income for most Medicaid and Children’s Health Insurance Program (CHIP) applicants and enrollees beginning in 2014. MAGI will also be used to determine eligibility for Advance Premium Tax Credits (APTCs) and Cost Sharing Reductions (CSRs) through the health insurance Marketplaces.  This Advocate’s Guide explains how MAGI works, and sets forth the guidelines that CMS has developed to implement and govern this new methodology.

At the National Academy for State Health Policy’s Annual Conference in October 2013, Dr. Leininger presented on one potential method that Medicaid agencies can use to prepare for the the health needs of its new enrollment population under the ACA. This presentation reviews Dr. Leininger's findings on the feasability of embedding a health needs assessment into Medicaid applications to predict this population's future health needs.

In June 2012, Medicaid enrollment reached 54.1 million as high unemployment and falling incomes led many families to turn to Medicaid for coverage. However, as economic conditions improved, enrollment growth in Medicaid slowed. An additional 1.3 million people enrolled in Medicaid between June 2011 and June 2012 (a growth rate of 2.5 percent) compared to the program’s most recent peak at the height of the recessionary period, where nearly 3.5 million additional people enrolled each period (growth rates of 7.8 and 7.2 percent). The issue brief provides further analysis of enrollment trends across all 50 states and DC as well as within select eligibility groups such as families, the aged and disabled, as well as adult expansions of non-disabled, non-elderly adults.