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Getting Medicaid Ready for 2014: Federal Requirements and State Options. September 24, 2010 Jocelyn Guyer. Medicaid’s Major Responsibilities in 2014. Coverage to 133% of the Federal Poverty Level (FPL) for adults and children Participate in “No Wrong Door” enrollment system
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Getting Medicaid Ready for 2014: Federal Requirements and State Options September 24, 2010 Jocelyn Guyer
Medicaid’s Major Responsibilities in 2014 • Coverage to 133% of the Federal Poverty Level (FPL) for adults and children • Participate in “No Wrong Door” enrollment system • Simplify and upgrade Medicaid eligibility determinations • No asset test for most populations • Use of “Modified Adjusted Gross Income” • Web-based enrollment
Medicaid Eligibility Expansion • 133% FPL for adults and children • No asset test • Enhanced federal matching funds for newly eligible adults • Benefits linked to “benchmark coverage” Source: Jocelyn Guyer, Martha Heberlein, and Robin Rudowitz, “Financing New Medicaid Coverage Under Health Reform: The Role of the Federal Government and States”, Kaiser Family Foundation, www.kff.org.
Implications for Texas’s Eligibility System • More determinations • Processing standards not changing • But, may be simpler determinations • Qualifying under new vs. old eligibility rules • Surveying option? • Identify people exempt from “benchmark benefits”
“No Wrong Door” Enrollment Process • Single, streamlined form for ALL health coverage programs • Apply online, in-person, by mail, or phone • Regardless of initial application, must be evaluated for and enrolled in the appropriate program • Electronic verification for income and citizenship/immigration status • No unnecessary information can be requested
Overview of Key Federal and State Responsibilities Federal • Establish standards for Exchange for subsidy determinations • Create federal standards for Exchanges to screen and enroll into Medicaid/CHIP • Verify key elements of eligibility • Create federal standards for “navigators” • “Reconcile” and adjust credits based on tax data
Overview of Key Federal and State Responsibilities State • Establish “No Wrong Door” enrollment system • Administer subsidy eligibility determinations • Screen and enroll CHIP and Medicaid-eligible into coverage • Authorize “navigators” to help people enroll in coverage
Information State Will Need • Name, address, date of birth • SSN (if lawful immigrant, additional information) • Employer coverage information • Income/family size from prior tax year • Additional information to determine Medicaid or CHIP eligibility (further guidance needed) • If applicable, reason for claiming a mandate exemption
Verification Requirements The federal government is expected to establish an online or electronic system for exchanges to verify key data elements: • Income and family size via IRS • Citizenship and immigration status via SSA or Homeland Security
Verification Requirements State responsibilities for verification: • Verify selected elements of eligibility • Address inconsistencies and allow people to correct information
Decide Whether Medicaid Will Take Responsibility for Subsidy Determinations
Get a Jump Start on Preparing • Option to move ahead with simplifications and improvements • Strengthen inter-agency data connections • Implement SSA citizenship option • Pursue web-based enrollment • Further streamline documentation • Longer renewal periods • May be able to use “pre-enrollment” options • Parents and children in Medicaid/CHIP • SNAP • Option to provide uniform benefits
Conclusion Major transformation is coming: • No wrong door enrollment • Online, streamlined application process • Use of electronic data exchange to verify information
Conclusion Options for Texas to get ahead: • Assign responsibility for subsidy eligibility determinations • Secure a jump start by simplifying Medicaid eligibility and phasing in improvements • Minimize complexity by adopting uniform Medicaid benefits
For more information Jocelyn Guyer jag99@georgetown.edu 202-784-4077 Our website: http://ccf.georgetown.edu/ Say Ahhh! Our child health policy blog: http://www.theccfblog.org/
Eligibility for a Subsidy • Citizen, national or “an alien lawfully present in the United States” • Income requirements • No access to “affordable” employer-based coverage • Enrolled in a qualified health plan offered through an Exchange