Medicaid Expansions

The expansion of Medicaid eligibility to Americans with incomes up to 138 percent of the federal poverty level should greatly increase access to coverage and services for people recently released from jail and, thus, improve health outcomes and reduce recidivism in this population. The population is disproportionately male, minority, and poor; suffers from high rates of mental and substance abuse disorders; and is expected to make up a substantial portion of the Medicaid expansion population. To ensure connections to needed services after release from jail, states could help inmates determine their eligibility and enroll in Medicaid; take advantage of federal grants to automate systems that determine eligibility; and include a robust array of behavioral health services in Medicaid benefit packages.

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.

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.

Medicaid comprises a significant portion of state budgets and is expected to grow as states expand coverage under the Affordable Care Act (ACA). Given this projected growth, understanding Medicaid’s financing structure, its burden on taxpayers, and any unintended consequences of the federal matching grant is particularly important. The matching grant, in place since the enactment of Medicaid, uses the Federal Medical Assistance Percentage (FMAP) to reimburse states for the federal share of states’ Medicaid expenditures. This study snapshot presents an overview of the estimated federal and state Medicaid tax burdens per family.

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.

This brief outlines key program design features of alternative Medicaid expansion models. It describes the premium assistance models Arkansas, Iowa, and Pennsylvania developed to use Medicaid funds to purchase private health insurance, as well as Michigan’s proposal to expand Medicaid using a health savings account model. Key themes emerging from these non-traditional proposals include: (1) a preference for solutions relying more on the private insurance market than on traditional Medicaid; and (2) an emphasis on higher enrollee cost-sharing, personal responsibility, and healthy behaviors.

This fact sheet details state and hospital roles and responsibilities in implementing HPE programs. It outlines components necessary for HPE programs as well as requirements for state plan amendment submission.  It also includes a hypothetical example to illustrate how the HPE determination process can help an uninsured individual during a hospital visit.

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.

Many states have worked tirelessly over the past two years to develop health insurance exchanges and prepare for the expansion of their Medicaid programs in order to meet the requirements of the ACA. Programs to expand coverage, however, do not necessarily ensure seamlessness for many individuals who are likely to experience shifts in program eligibility due to changing circumstances (e.g., income fluctuations, family composition changes, etc.). A number of states are actively working to limit the impact of changes in program eligibility by developing policies that limit either the incidence of program eligibility changes and/or the impact those changes have on individual consumers. Various emerging state approaches take into account program history, the desire for state flexibility, and the political and operational challenges states face in developing coverage expansions that work for consumers, stakeholders, and policy makers.

The ACA has created new health insurance coverage opportunities for millions of low-income Americans. Many of these individuals, however, are likely to "churn" in and out of eligibility for Medicaid and marketplace coverage due to fluctuating income and changing family circumstances. Adults who change health insurance coverage are less likely to have a usual source of care and may delay care during coverage transitions. This brief outlines key steps that states can take to reduce the potential gaps in coverage caused by churn. It includes examples from states that have begun to address this issue and outlines concrete strategies for states to mitigate the impact of coverage transitions.