Getting Medicaid Ready for 2014: Federal Requirements and State Options September 24, 2010 Jocelyn...

Getting Medicaid Ready for 2014: Federal Requirements and State

Options

September 24, 2010Jocelyn Guyer

Medicaid’s Major Responsibilities in 2014

Coverage to 133% of the Federal Poverty Level (FPL) for adults and children

Participate in “No Wrong Door” enrollment system

Simplify and upgrade Medicaid eligibility determinations No asset test for most populations Use of “Modified Adjusted Gross Income” Web-based enrollment

Medicaid Eligibility Expansion

133% FPL for adults and children

No asset test Enhanced federal

matching funds for newly eligible adults

Benefits linked to “benchmark coverage”

Year Enhanced Matching Rates for Newly Eligible Adults

2014 100%

2015 100%

2016 100%

2017 95%

2018 94%

2019 93%

2020 and after

90%

Source: Jocelyn Guyer, Martha Heberlein, and Robin Rudowitz, “Financing New Medicaid Coverage Under Health Reform: The Role of the Federal Government and States”, Kaiser Family Foundation, www.kff.org.

Implications for Texas’s Eligibility System

More determinations Processing standards not

changing But, may be simpler

determinations Qualifying under new vs. old

eligibility rules Surveying option?

Identify people exempt from “benchmark benefits”

“No Wrong Door” Enrollment System

“No Wrong Door” Enrollment Process

Single, streamlined form for ALL health coverage programs

Apply online, in-person, by mail, or phone

Regardless of initial application, must be evaluated for and enrolled in the appropriate program

Electronic verification for income and citizenship/immigration status

No unnecessary information can be requested

Overview of Key Federal and State Responsibilities

Federal Establish standards for Exchange for subsidy

determinations Create federal standards for Exchanges to screen

and enroll into Medicaid/CHIP Verify key elements of eligibility Create federal standards for “navigators” “Reconcile” and adjust credits based on tax data

Overview of Key Federal and State Responsibilities

State Establish “No Wrong Door” enrollment system Administer subsidy eligibility determinations Screen and enroll CHIP and Medicaid-eligible into

coverage Authorize “navigators” to help people enroll in

coverage

Information State Will Need

①Name, address, date of birth ②SSN (if lawful immigrant, additional information) ③Employer coverage information④Income/family size from prior tax year ⑤Additional information to determine Medicaid

or CHIP eligibility (further guidance needed)⑥If applicable, reason for claiming a mandate

exemption

Verification Requirements

The federal government is expected to establish an online or electronic system for exchanges to verify key data elements: Income and family size via IRS Citizenship and immigration

status via SSA or Homeland Security

Verification Requirements

State responsibilities for verification: Verify selected elements of

eligibility Address inconsistencies

and allow people to correct information

Use of Tax Data to Verify Income

Key Options for Texas

Decide Whether Medicaid Will Take Responsibility for Subsidy Determinations

Get a Jump Start on Preparing

Option to move ahead with simplifications and improvements Strengthen inter-agency data connections Implement SSA citizenship option Pursue web-based enrollment Further streamline documentation Longer renewal periods

May be able to use “pre-enrollment” options Parents and children in Medicaid/CHIP SNAP

Option to provide uniform benefits

Conclusion

Major transformation is coming: No wrong door enrollment Online, streamlined application process Use of electronic data exchange to verify

information

Conclusion

Options for Texas to get ahead: Assign responsibility for subsidy

eligibility determinations Secure a jump start by simplifying

Medicaid eligibility and phasing in improvements

Minimize complexity by adopting uniform Medicaid benefits

For more information

Jocelyn Guyerjag99@georgetown.edu202-784-4077

Our website:http://ccf.georgetown.edu/

Say Ahhh! Our child health policy blog:http://www.theccfblog.org/

Eligibility for a Subsidy

Citizen, national or “an alien lawfully present in the United States”

Income requirements No access to “affordable”

employer-based coverage Enrolled in a qualified health

plan offered through an Exchange