This document summarizes key Medicaid changes under the Patient Protection and Affordable Care Act (PPACA). It outlines provisions for Medicaid expansion including newly eligible individuals up to 133% of the federal poverty level and increased CHIP income eligibility. It also discusses funding structures, state maintenance of effort requirements, new benefits, changes to the Children's Health Insurance Program, reductions to Disproportionate Share Hospital payments, and outreach and enrollment requirements. The projected impact is estimated to be 16 million additional Medicaid beneficiaries, with the federal government paying 95.4% of increased costs.

1. MEDICAID CHANGES UNDER PPACA George H. Ritter Wise Carter 401 E. Capitol Street Jackson, Mississippi 39201 (601) 968-5526

2. Major Components Medicaid expansion CHIP-related provisions DSH contraction Outreach and enrollment provisions

3. Medicaid Expansion Newly Eligibles Non-elderly (under 65), non-pregnant individuals Not enrolled or entitled to be enrolled in Medicare Part A or enrolled in Medicare Part B Income is 133% or less of FPL Not otherwise eligible for Medicaid Poverty-related children Raises income eligibility level from 100% of FPL to 133% FPL Certain individuals with disabilities not currently eligible because— Do not meet SSI definition of disabled, or Have income or asset levels greater than state’s threshold

4. Funding for Newly Eligibles Optional Phase-in Period 4/1/2010 thru 1/1/2014 State option No federal funding Mandatory Period Beginning 1/1/2014 100% federal funding Beginning 2020 Decreases to 90% federal funding

5. State Maintenance of Effort Requirements Loss of FFP if eligibility standards, methodologies, or procedures are made more restrictive than they were as of 3/23/2010 Can’t balance budget by tightening eligibility standards Exception for non-pregnant, non-disabled adults with AGI greater than 133% FPL Available between 1/1/2011 and 12/31/2013 Federal waiver required

6. New Benefits Premium assistance (optional) Birthing centers (mandatory) Adult preventive care (mandatory and optional components) Smoking cessation for pregnant women (mandatory) Home and community based attendant care (optional) Health homes for patients with certain chronic conditions (optional)

7. CHIP-Related Provisions Thru FY2015 Current CHIP structure maintained FY2016 – FY2019 25% increase in federal CHIP match Currently not appropriated If not appropriated, coverage will be available through health insurance exchanges Childhood Obesity Demonstration Project $25 billion for FY2010-FY2014 Many other details

8. DSH Contraction Beginning FY2014 Medicare DSH payments reduced by approximately 75% ($22B over 10 years) Medicaid DSH payments reduced from by approximately 50% ($14.1B over 10 years) Hospitals may qualify for additional DSH payments based on several complex factors Exact amounts cannot be determined, but reimbursements will decrease substantially if expanded coverage does not offset the DSH cuts Additional limitations on judicial review

9. Outreach and Enrollment Provisions Internet website enrollment No face to face meetings Coordination with health insurance exchanges Exchanges screen applicants for Medicaid and CHIP eligibility Medicaid screens applicants determined ineligible for eligibility in qualified plans through exchanges Required outreach for vulnerable populations Unaccompanied homeless youth Racial and ethnic minorities Individuals with HIV/AIDS Presumptive eligibility determinations by hospitals Extended to all Medicaid eligible populations (previously limited to certain groups) During presumptive eligibility period, claims will not be reviewed for errors in the state’s eligibility determinations

10. Projected Impact Additional 16 million Medicaid beneficiaries 27.4% increase Federal government will pay 95.4% of the increased cost UPL expected to increase based on increased enrollment Federal matching rate will be a combination of— Current matching rates on current eligibles Expansion state maximum rate for certain childless adults Higher matching rates on newly eligibles

11. For more information Congressional Research Service, Medicaid and the State Children’s Health Insurance Program (CHIP) Provisions in PPACA, April 28, 2010 www.crs.gov