MEDICAID CHANGES UNDER PPACA<br />George H. Ritter<br />Wise Carter<br />401 E. Capitol Street<br />Jackson, Mississippi 3...
Major Components<br />Medicaid expansion<br />CHIP-related provisions<br />DSH contraction<br />Outreach and enrollment pr...
Medicaid Expansion<br />Newly Eligibles<br />Non-elderly (under 65), non-pregnant individuals<br />Not enrolled or entitle...
Funding for Newly Eligibles<br />Optional Phase-in Period<br />4/1/2010 thru 1/1/2014<br />State option<br />No federal fu...
State Maintenance of Effort Requirements<br />Loss of FFP if eligibility standards, methodologies, or procedures are made ...
New Benefits<br />Premium assistance (optional)<br />Birthing centers (mandatory)<br />Adult preventive care (mandatory an...
CHIP-Related Provisions<br />Thru FY2015<br />Current CHIP structure maintained<br />FY2016 – FY2019<br />25% increase in ...
DSH Contraction<br />Beginning FY2014<br />Medicare DSH payments<br /> reduced by approximately 75% ($22B over 10 years)<b...
Outreach and Enrollment Provisions<br />Internet website enrollment<br />No face to face meetings<br />Coordination with h...
Projected Impact<br />Additional 16 million Medicaid beneficiaries<br />27.4% increase<br />Federal government will pay 95...
For more information<br />Congressional Research Service, Medicaid and the State Children’s Health Insurance Program (CHIP...
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Medicaid changes under PPACA

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Presented during MHA's Sept. 30 seminar on health care reform

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Medicaid changes under PPACA

  1. 1. MEDICAID CHANGES UNDER PPACA<br />George H. Ritter<br />Wise Carter<br />401 E. Capitol Street<br />Jackson, Mississippi 39201<br />(601) 968-5526<br />
  2. 2. Major Components<br />Medicaid expansion<br />CHIP-related provisions<br />DSH contraction<br />Outreach and enrollment provisions<br />
  3. 3. Medicaid Expansion<br />Newly Eligibles<br />Non-elderly (under 65), non-pregnant individuals<br />Not enrolled or entitled to be enrolled in Medicare Part A or enrolled in Medicare Part B<br />Income is 133% or less of FPL<br />Not otherwise eligible for Medicaid<br />Poverty-related children<br />Raises income eligibility level from 100% of FPL to 133% FPL<br />Certain individuals with disabilities not currently eligible because—<br />Do not meet SSI definition of disabled, or<br />Have income or asset levels greater than state’s threshold<br />
  4. 4. Funding for Newly Eligibles<br />Optional Phase-in Period<br />4/1/2010 thru 1/1/2014<br />State option<br />No federal funding<br />Mandatory Period<br />Beginning 1/1/2014<br />100% federal funding<br />Beginning 2020<br />Decreases to 90% federal funding<br />
  5. 5. State Maintenance of Effort Requirements<br />Loss of FFP if eligibility standards, methodologies, or procedures are made more restrictive than they were as of 3/23/2010<br />Can’t balance budget by tightening eligibility standards<br />Exception for non-pregnant, non-disabled adults with AGI greater than 133% FPL<br />Available between 1/1/2011 and 12/31/2013<br />Federal waiver required<br />
  6. 6. New Benefits<br />Premium assistance (optional)<br />Birthing centers (mandatory)<br />Adult preventive care (mandatory and optional components)<br />Smoking cessation for pregnant women (mandatory)<br />Home and community based attendant care (optional)<br />Health homes for patients with certain chronic conditions (optional)<br />
  7. 7. CHIP-Related Provisions<br />Thru FY2015<br />Current CHIP structure maintained<br />FY2016 – FY2019<br />25% increase in federal CHIP match<br />Currently not appropriated<br />If not appropriated, coverage will be available through health insurance exchanges<br />Childhood Obesity Demonstration Project<br />$25 billion for FY2010-FY2014<br />Many other details<br />
  8. 8. DSH Contraction<br />Beginning FY2014<br />Medicare DSH payments<br /> reduced by approximately 75% ($22B over 10 years)<br />Medicaid DSH payments<br /> reduced from by approximately 50% ($14.1B over 10 years) <br />Hospitals may qualify for additional DSH payments based on several complex factors<br />Exact amounts cannot be determined, but reimbursements will decrease substantially if expanded coverage does not offset the DSH cuts<br />Additional limitations on judicial review<br />
  9. 9. Outreach and Enrollment Provisions<br />Internet website enrollment<br />No face to face meetings<br />Coordination with health insurance exchanges<br />Exchanges screen applicants for Medicaid and CHIP eligibility<br />Medicaid screens applicants determined ineligible for eligibility in qualified plans through exchanges<br />Required outreach for vulnerable populations<br />Unaccompanied homeless youth<br />Racial and ethnic minorities<br />Individuals with HIV/AIDS<br />Presumptive eligibility determinations by hospitals<br />Extended to all Medicaid eligible populations (previously limited to certain groups)<br />During presumptive eligibility period, claims will not be reviewed for errors in the state’s eligibility determinations<br />
  10. 10. Projected Impact<br />Additional 16 million Medicaid beneficiaries<br />27.4% increase<br />Federal government will pay 95.4% of the increased cost<br />UPL expected to increase based on increased enrollment<br />Federal matching rate will be a combination of—<br />Current matching rates on current eligibles<br />Expansion state maximum rate for certain childless adults<br />Higher matching rates on newly eligibles<br />
  11. 11. For more information<br />Congressional Research Service, Medicaid and the State Children’s Health Insurance Program (CHIP) Provisions in PPACA, April 28, 2010<br />www.crs.gov<br />

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