The Kaiser Commission on Medicaid and the Uninsured, in conjunction with the Georgetown University Center for Children and Families, released its 10th annual 50-state survey of Medicaid and CHIP eligibility rules.[1] According to the report, despite the strain on state budgets resulting from the economic downturn, 48 states and the District of Columbia have maintained coverage or made targeted improvements in the Medicaid and the Children's Health Insurance Program (CHIP) in 2010. Only two states—Arizona and New Jersey—have made coverage reductions.
However, this stability in the Medicaid program was largely due to provisions included in the American Recovery and Reinvestment Act of 2009 (ARRA) that provides temporary Medicaid fiscal relief to states through June 2011. In addition, the law includes maintenance-of-effort (MOE) provisions which limit a state’s ability to reduce Medicaid spending by tightening eligibility rules to decrease the number of people who can enroll in Medicaid.[2]
The report found that most of the coverage expansion policies have focused on children:
- Three states—Colorado, Kansas, and Oregon—increased income eligibility in Medicaid/CHIP for children.
- Several states have taken advantage of a provision in the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) to draw down federal funding to cover lawfully residing immigrant children (six states) and pregnant women (five of the six states) during their first five years residing in the country.
Medicaid coverage for parents in 2010 was not as positive:
- Only one state—Colorado—expanded Medicaid coverage for parents.
- In 2010, 33 states did not cover parents up to 100 percent of the federal poverty level (FPL) ($18,310 for a family of three).
- The median eligibility threshold for parents is 64 percent FPL, and 16 states limit eligibility to below 50 percent FPL ($9,155 for a family of three).
Beginning in 2014, the Patient Protection and Affordability Care Act (ACA) provides additional funding for states to cover their childless adults up to 133 percent FPL. However, states have the option—though not the funding—to extend coverage to this group prior to 2014. In 2010, three states took advantage of this option:
- Connecticut, which extended Medicaid coverage to adults with incomes up to 56 percent FPL;
- Washington, D.C., which used this option along with a waiver to extend coverage to adults up to 200 percent FPL; and
- California, which also used this option along with a waiver to extend coverage to adults up to 200 percent FPL.
States also took advantage of options provided under CHIPRA to improve their enrollment and renewal procedures, reduce burdens on families and increase the efficiency of the program:
- 29 states verified citizenship status by relying on electronic data to match with the Social Security Administration (SSA).
- A smaller number of states have moved to administrative verification of information rather than asking families to submit paper documentation, adopting presumptive eligibility and continuous eligibility, and eliminating asset test and face-to-face interview requirements. However, just as with the eligibility enrollment improvements, most of the improvements made were with regard to streamlining the procedures for children.
Another improvement states have begun to make is with respect to technology. All states, including the District of Columbia, post their Medicaid applications online and 32 accept the electronic submission of the application. While there is still room for improvement, a 2010 proposed rule, which would provide states with a 90 percent matching rate to prepare their Medicaid eligibility systems for health reform, will likely help states make progress in this arena.
The report concludes by noting that states will need to continue to build on the work they have accomplished so far. This will not be an easy task given tight budgets and the fact that the ARRA funding ends in June 2011. However, it is important for states to begin laying the groundwork sooner rather than later, especially when the ACA provides them with new opportunities to modernize, streamline, and continue to improve Medicaid and CHIP.
[1] Heberlein, M., Brooks, T., and Guyer J., Artiga, S. and Stephens, J. (2011, January). Holding Steady, Looking Ahead: Annual Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost Sharing Practices in Medicaid and CHIP, 2010-2011. Georgetown University Center for Children and Families and Kaiser Commission on Medicaid and the Uninsured. Retrieved January 20, 2011, from www.kff.org/medicaid/upload/8130.pdf.
[2] The MOE restrictions did not apply to the two states—Arizona and New Jersey—that made coverage reductions.
