Final camillo appam presentation (paper 2448)
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  • 1. Implementing Expanded Medicaid Eligibility and MAGI Under ACA: State Perspectives Cheryl CamilloPresentation to the Fall Research Conference of the Association for Public Policy Analysis & Management November 5, 2011
  • 2. Pre-ACA Medicaid and CHIP Eligibility  To be eligible, an individual must fit into a category: parent/caretaker relative, child, pregnant woman, aged, blind, or disabled  Strong links to welfare/entitlement programs  Eligibility determined on a case-by-case basis by comparing monthly income and assets to standards and verifying other requirements, such as residency  States must use methodologies of AFDC or SSI cash assistance programs for determining household composition and financial eligibility 2
  • 3. Eligibility-Related ACA ProvisionsMandatory as of January 1, 2014  Expands Medicaid eligibility to 133% FPL (plus 5% disregard) for non-elderly adults not previously categorically eligible  Parents must enroll children  Provides benchmark benefit package to those made eligible via this expansion  Provides increased FFP for those “newly eligible” as of December 2009 3
  • 4. Eligibility-Related ACA ProvisionsMandatory as of January 1, 2014  Mandates that eligibility for most individuals be determined using modified adjusted gross income (MAGI) as defined in the Internal Revenue Code  Requires “income conversion” - conversion of states’ current net income standards, including disregards, into equivalent MAGI income standard – No asset test  Requires simplified and coordinated eligibility system between all insurance affordability programs – Single, streamlined application – No wrong door – Data matching 4
  • 5. August 17, 2011 Proposed Rules  Apply income conversion to establish equivalence at the aggregate, versus individual, level  Give more flexibility to states to handle income changes  Use IRS definitions for household, family size, and income, with some exceptions  Extend coverage month to coordinate coverage through the exchange 5
  • 6. August 17, 2011 Proposed Rules  Mandate that states obtain and use reasonably compatible Federal data from Federal data hub  Require states to use single, streamlined application developed by HHS, or own application with supplemental forms as approved by HHS  Permit Medicaid agency to delegate Medicaid and MAGI eligibility determinations (but not policy or oversight) to government-operated exchanges  Expect use of shared eligibility system to place most individuals in insurance affordability programs  Solicit comments on approaches to identify newly eligible 6
  • 7. State Feedback  April 14 SHARE Webinar “Medicaid Eligibility Determination under the ACA: Challenges for States”  May 21 SHARE-sponsored workshop included Medicaid and CHIP eligibility directors, national policy experts, IRS representative, and Mathematica researchers – Discussed scenarios presented by states  Follow-up telephone conversations and in-person meetings with state officials 7
  • 8. State Challenges  Uncertainty regarding ACA law and implementation  Perform and receive approval for income conversion  Select methodology for determining newly eligible  Enhancement of automated systems  Establishment of organization, delegation, coordination, and oversight  Production of new application/outreach materials  Some individuals no longer eligible  Some individuals with lesser benefit package 8
  • 9. Implications  Insurance affordability programs system would further Medicaid’s delinking from traditional welfare programs  Investment in systems would yield future benefits  Development of data culture could enrich enterprises 9
  • 10. Outlook  Medicaid has undergone significant eligibility changes in the program’s 46 year history: – SSI – Welfare reform – delinkage from cash assistance – CHIP  Implementation assistance includes: – Income conversion evaluation/TA contract – Enroll UX 2014 – Learning Collaboratives to Support the Development of a High- Performing State Health Coverage Program – Increased Federal funding for eligibility determination systems through 2015 10
  • 11. For More Information  Please contact: – Cheryl Camillo • ccamillo@mathematica-mpr.com 11 Mathematica® is a registered trademark of Mathematica Policy Research.