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Medicaid and CHIP:
On the Road to Reform

                                    Cindy Mann, JD
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Our Mission
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Implementing the A ordable Care Act

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A System of Coverage
New Paradigm

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                          Children below
                         200% of poverty
                                           23%
!!M./.0A$V./&$913?&4)$                               16%

                                                                          12%


                          Children above   6%        5%
                         200% of poverty
                                                                          5%

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Minimum Eligibility Levels
               Now and 2014
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                                 C21,1G121#"&;$:$2!&                   C21,1G121#"&;$:$2!&&
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* 5 States provide Medicaid or Medicaid look-alike coverage to certain childless adults; 15 States
provide a limited benefit package to certain childless adults.
2014 Health Insurance Subsidies

400%
FPL


235%   CY)0+*,$&F5G!131$!&
FPL                                            Varies
                                              by State
                             K$31)+13P/67'&
133%
 FPL
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   0
             Adults              Children
Keys to Enrollment
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!! "3,&1/6$/.->B&$0*0)&-0$
Modernizing Medicaid IT Systems&&

   Three Foundational Elements


CMS/OCIIO – IT Guidance        OCIIO: FOA – 5 State
  Eligibility Systems          Exchange Prototypes


            CFR        dera
                           l
                 of Fe
             Code lations
               Regu
Coverage: Pathway to Better Care, Better
    Health, Lower Per Capital Costs


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Medicaid and CHIP: On the Road to Reform

  • 1. Medicaid and CHIP: On the Road to Reform Cindy Mann, JD !"#$%&'()*$+,-./.0)12)31 $ %.1&4)31 $ !&/)&1$531$"&,.42.,6$!789$2/,$#(1:&*$;$!&1<=42<3/ $ !&/)&10$531$"&,.421&$;$"&,.42.,$#&1:.4&0 $
  • 2. Our Mission !! !"#$2.-0$)3$>&$2$-2?31$5314&$2/,$2$ )1(0)@31)A*$'21)/&1$531$)A&$43/</(2B$ .-'13:&-&/)$35$A&2B)A$2/,$A&2B)A$421&$ 531$2BB$+-&1.42/0$ !! !"!#$4211.&0$)A.0$-.00.3/$531@21,$@.)A$2$ '21<4(B21$&-'A20.0$3/$-2C./D$"&,.42.,$ 2/,$!789$)A&$>&0)$'13D12-0$)A&*$42/$>&$ !! E&/&=4.21.&0$21&$3(1$534(0$ !! 921)/&10A.'0$21&$41.<42B$)3$0(44&00$
  • 3. Implementing the A ordable Care Act !!F31C./D$@.)A$#)2)&0$GH3:I0$3J4&06$"&,.42.,6$!7896$ 8/0(12/4&$!3--.00.3/&10K$ !!!331,./2</D$@.)A$L!88L$2/,$3)A&1$M&,&12B$+D&/4.&0N %&'21)-&/)0$ !!#A21./D$.,&20$2>3()$@A2)$1&531-$-&2/0$@.)A$2$>132,$ 2112*$35$0)2C&A3B,&10$ !!913-(BD2</D$1&D(B2<3/0$2/,$D(.,2/4&O$'13:.,./D$ )&4A/.42B$200.0)2/4&$ P$
  • 4. A System of Coverage
  • 5. New Paradigm !! Q3)$2$R025&)*$/&)S$>()$2$5(BB$'21)/&1$./$ 200(1./D$43:&12D&$531$2BB$ !! TB.D.>B&$U$&/13BB&,$ !! V2@$43/)&-'B2)&0$2$!"!#$%&-2,&$('$35$ ,.W&1&/)$43-'3/&/)0$)3$24A.&:&$ 0&2-B&00$43:&12D&6$X(2B.)*$2/,$430)$ 43/)2./-&/)$3>?&4<:&0$
  • 6. ;$!!-*!&.(-%&/0123($*B!&/-:$(+,$&CD-(#!E& F5))$!!&1!&'-!!1G2$& !!"2YT/13BB$ '$()$*#+,$&-.&/0123($*&41#0-5#&6$+2#0& & 7*!5(+*)$8&9"&'-:$(#"&;$:$28&<==>?@AA=& Children below 200% of poverty 23% !!M./.0A$V./&$913?&4)$ 16% 12% Children above 6% 5% 200% of poverty 5% !!!3:&1./D$Z.,0$2/,$ M2-.B.&0$
  • 8. Minimum Eligibility Levels Now and 2014 '-J52+I-*& /5(($*#&K1*1%5%& @A<N&K1*1%5%& C21,1G121#"&;$:$2!& C21,1G121#"&;$:$2!&& L+:$(+,$M& /0123($*& <AAOP<QQO& @QRO& L@QROM& '+($*#!& N@O& <QQO& LSNOM& T1!+G2$3&U352#!& VNO& <QQO& LFF7?($2+#$3M& W#0$(&U352#!& AOX& <QQO& * 5 States provide Medicaid or Medicaid look-alike coverage to certain childless adults; 15 States provide a limited benefit package to certain childless adults.
  • 9. 2014 Health Insurance Subsidies 400% FPL 235% CY)0+*,$&F5G!131$!& FPL Varies by State K$31)+13P/67'& 133% FPL /0123($*& K$31)+13&U352#!& 0 Adults Children
  • 10. Keys to Enrollment !! #&2-B&00/&00$@.)A$)A&$TY4A2/D&6$@A.B&$'13-3</D$ -2/*$,3310$)3$43:&12D&$./4B(,./D$@.)A$)1(0)&,$ 43--(/.)*$'21)/&10$ !! “^A&$A.DA&0)$B&:&B$35$G4(0)3-&1K$0&1:.4&$2/,$0(''31)S$$ !! "2C&$.)$0.-'B&_$ !! "3,.=&,$+,?(0)&,$H1300$8/43-&$G"+H8K$ !! %2)2`,1.:&/$T/13BB-&/)$2/,$a&/&@2B$ !! "3,&1/6$/.->B&$0*0)&-0$
  • 11. Modernizing Medicaid IT Systems&& Three Foundational Elements CMS/OCIIO – IT Guidance OCIIO: FOA – 5 State Eligibility Systems Exchange Prototypes CFR dera l of Fe Code lations Regu
  • 12. Coverage: Pathway to Better Care, Better Health, Lower Per Capital Costs '-J52+I-*& 6$+2#0& CYJ$(1$*)$& !"#$%&'()&$ W.&/+($& /-!#&