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Minimum Essential Coverage

Minimum Essential Coverage. Individuals must maintain “ Minimum Essential Coverage ” or face a tax penalty An individual eligible for “ Minimum Essential Coverage ” is not eligible for tax credits Most, but not all, Medicaid programs provide “ Minimum Essential Coverage ”. Pregnant Women.

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Minimum Essential Coverage

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  1. Minimum Essential Coverage • Individuals must maintain “Minimum Essential Coverage” or face a tax penalty • An individual eligible for “Minimum Essential Coverage” is not eligible for tax credits • Most, but not all, Medicaid programs provide “Minimum Essential Coverage”

  2. Pregnant Women • For pregnant women, new coverage opportunities intersect with existingMedicaid coverage during pregnancy • All states cover pregnant women under Medicaid • Some go beyond 133% FPL • Up to 300% FPL in some states • Some states cover all services in the State Plan; others cover only services related to pregnancy

  3. Pregnant Women: The Bottom Line (1) • Medicaid for pregnancy related services is not Minimum Essential Coverage • No penalty if enrolled in Medicaid for pregnancy related services in 2014 • Not eligible for benchmark plans through Medicaid expansion if pregnant at enrollment

  4. Pregnant Women: The Bottom Line (2) • If pregnant at enrollment, eligible for Medicaid for pregnancy related services • Should be able to enroll in both Medicaid for pregnancy related services and a QHP with an advance payment premium tax credit, but… • Marketplaces were built before the final rule and structures are unknown…

  5. Additional Medicaid Programs NotMinimum Essential Coverage • Additional Medicaid programs that do not provide Minimum Essential Coverage • Family Planning Services §1396a(a)(10)(A)(ii)(XXI) • Tuberculosis-Related Services §1396a(a)(10)(A)(ii)(XII) • Emergency Medical Conditions Only §1396b(v)

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