NV Exchange Summit Medicaid and CHIP in ACA presentation


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June 2013

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NV Exchange Summit Medicaid and CHIP in ACA presentation

  1. 1. Division of Welfare andSupportive ServicesJune 13-14, 2013Nevada Department ofHealth and Human ServicesMedicaid and CHIP In ACA
  2. 2. Affordable CareAct (ACA) OverviewThe ACA expands access to health insurance through improvementsin Medicaid, the establishment of Affordable Insurance Exchanges, andcoordination between Medicaid, the Childrens Health InsuranceProgram (CHIP), and Exchanges.The alignment of the methods for determining eligibility is one part ofan overall system established by the Affordable Care Act that allows forreal-time eligibility determinations of most applicants and allows forprompt enrollment of individuals in the `insurance affordabilityprogram for which they qualify. Insurance affordability programsinclude Medicaid, CHIP, advance payments of premium tax credits andcost-sharing reductions through the Exchange.
  3. 3. Insured2,076,72177%Uninsured604,86723%Insurance Status
  4. 4. 0% to Below100% FPL207,696 35%100% to Below200% FPL177,177 29%200% toBelow 300%FPL 116,91419%300% to Below400% FPL40,607 7%400% andabove 62,47310%Uninsured by Income-to-Poverty Ratio
  5. 5. 300,000350,000400,000450,000500,000Jul-13Aug-13Sep-13Oct-13Nov-13Dec-13Jan-14Feb-14Mar-14Apr-14May-14Jun-14Jul-14Aug-14Sep-14Oct-14Nov-14Dec-14Jan-15Feb-15Mar-15Apr-15May-15Jun-15Total Medicaid Projections November 12 Estimated Additional HCA Optional Medicaid Projections (Starts January 14)340,091 Recipients or 196,584 Cases450,685 Recipients or 260,511 Cases490,103 Recipients or 283,297 Cases
  6. 6. DWSS Eligibility Engineo Integrate•Silver State Health Insurance Exchange (SSHIX)•Medicaid/CHIPo Customizable Rules•Easily adapts to regulation changeo Accommodates Electronic Verificationo Communicate with the Federal Data Hub•Social Security Administration• Internal Revenue Service•Department of Homeland Security
  7. 7. Shared System Overview
  8. 8. MedicalAssistance Programso Family Medical and new Adult Coverageo Nevada Check Upo Emergency Medical Coverageo Breast & Cervical Cancer Programo Medicaid for the Aged, Blind, and Disabled (MAABD)o Medicare Beneficiaries
  9. 9. 138100200138220159138200159138 138050100150200250Children 0-5 All Children 6-18 CHIP Pregnant Women Parent/Caretaker Childless Adults 19-65FPLEligibility Current and FutureCurrent FPL Limit Future FPL Limit January 2014
  10. 10. Federal Poverty Limits (FPL) by Household SizeHH Size 138% FPL 159% FPL 185% FPL 200% FPL1 $1,321 $1,522 $1,771 $1,9152 $1,784 $2,055 $2,391 $2,5853 $2,246 $2,588 $3,011 $3,2554 $2,708 $3,120 $3,631 $3,9255 $3,171 $3,653 $4,250 $4,5956 $3,633 $4,186 $4,870 $5,2657 $4,095 $4,718 $5,490 $5,9358 $4,557 $5,251 $6,110 $6,605
  11. 11. MAGI Incomeo MAGI-Modified Adjust Gross Income• Methodology for how income is counted and how householdcomposition and family size are determined. (Based on federal taxrules for determining adjusted gross income with some modification)oAdjusted Gross Income (AGI) plus•Any foreign earned income excluded from taxes;•Tax exempt interest; and•Tax exempt Social Security Incomeo Household Income•Sum of the taxpayer’s MAGI plus the MAGI of tax dependents in thefamily, if required to file
  12. 12. CONT…..oTaxable income counted for Medicaid and CHIPExcept:•Scholarships, fellowship grants and awards used for educationpurposes•American Indian and Alaskan Native income derived fromdistributions, payments, ownership interests and real propertyusage rights•Lump sum
  13. 13. MAGI HouseholdoTax payers and tax dependents use tax household with limitedexceptions•Household determined by tax dependencyoParents, children and siblings are included in same household•Stepparents and parents treated same•Children and siblings with or without income included in samehousehold as rest of family•Older children included in family if claimed as tax dependent byparents•Child income does not count if child not required to file a taxreturn
  14. 14. MedicalAssistance to theAged, Blind and Disabled (MAABD)OverviewSSIPublic LawInstitutional over 30 daysInstitutional under 30 daysHome and community based waiver programsKatie BeckettHealth Insurance for Work Advancement (HIWA)Medicare Beneficiaries (Premiums, Co-insurance and Deductiblesfor Medicare Covered Services)
  15. 15. Questions???