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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 [email protected]
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
