Medicaid and CHIP
CMS State Resources FAQ: Medicaid Eligibility Determinations, Medicaid/Exchange Interactions, and §1115 Demonstrations that Use Enrollment Caps
Posted on May 22, 2013
The interaction between Medicaid and Exchanges around eligibility determination issues represents one of the most important and complex aspects of the ACA. An estimated 28 million adults, along with 19 million children, can be expected to transition at least once annually between insurance affordability programs, as Medicaid and premium subsidies are termed under implementing CMS regulations. Collaboration between Medicaid agencies and Exchanges is essential in order to avert unnecessary delays in eligibility determinations and breaks in coverage that in turn can affect not only the affordability of care but access itself, given the link between coverage and health care access through plans’ provider networks…
Posted on May 20, 2013
The Centers for Medicare and Medicaid Services (CMS) released a letter to state health officials and Medicaid Directors regarding enrollment of uninsured individuals into Medicaid and CHIP. With the looming enactment of the Affordable Care Act’s (ACA) provision on Medicaid expansion, CMS intends to assist states by providing optional tools that will aid in their transition to the new eligibility and enrollment models. The letter specifically addresses and provides guidance on these five enrollment strategies:
- Implementing the early adoption of Modified Adjusted Gross Income (MAGI)-based rules;
- Extending the Medicaid renewal period so renewals that would otherwise occur during the first quarter of calendar year 2014 will occur later;
- Enrolling individuals into Medicaid based upon Supplemental Nutrition Assistance Program (SNAP) eligibility;
- Enrolling parents into Medicaid based upon children’s income eligibility; and
- Adopting 12-month continued eligibility for parents and other adults.
CMS purports that states choosing to utilize one of these outlined approaches will be met with a streamlined review and approval process.
Posted on May 15, 2013
The Congressional Budget Office (CBO), in conjunction with the Joint Committee on Taxation (JCT), issued updated budget projections for fiscal years 2014-2023, which include updated impact estimates of the insurance provisions in the Affordable Care Act (ACA). Slower than anticipated growth in health care spending, particularly in programs such as Medicare and Medicaid, is one of several factors that influenced the revised estimates…
Posted on May 14, 2013
A study released by The George Washington University finds that churning, the process of moving in and out of Medicaid in response to income fluctuations, increases hospitalizations and costs for Medicaid beneficiaries. The Continuity of Medicaid Coverage: An Update reports that individuals enrolled in Medicaid for 12 months consecutively pay on average $333/month in medical bills, while those enrolled for one month at a time pay $625/month. The study released last week was funded by the Association for Community Affiliated Plans (ACAP).
Posted on May 14, 2013
The Centers for Medicare and Medicaid Services (CMS) released a proposed rule concerning reductions to Disproportionate Share Hospital (DSH) payments. Pursuant to the Affordable Care Act (ACA), the federal government had intended to cut DSH payments beginning in 2014, as the law’s Medicaid expansion would negate the need for such payments. Since the Supreme Court’s decision rendered Medicaid expansion optional, the federal government has elected to delay the DSH payment reduction until 2015 when they have a more accurate assessment of the nation’s uncompensated care level after initial implementation of the ACA.
A fact sheet summarizing the rule can be found here.
Posted on May 2, 2013
The Centers for Medicare and Medicaid Services (CMS) and Health Resources and Services Administration (HRSA) released a joint information bulletin detailing the opportunity to coordinate care between Medicaid and the Ryan White HIV/AIDS Program. The expansion of Medicaid under the Affordable Care Act (ACA) will provide health care access to many people living with HIV/AIDS, therefore necessitating the need for CMS and HRSA to ensure that Medicaid and Ryan White HIV/AIDS programs are poised to collaborate and coordinate care for this population. The two federal agencies will offer webinars and training in the following areas: eligibility, enrollment, essential community providers, managed care practices, and integrated care models for those living with HIV/AIDS.
Posted on April 30, 2013
The Brookings Institution recently released a study that indicates how value-based payments and small, conscientious quality improvements to both the private and public insurance sectors can significantly reduce health care costs in the future. Bending the Cure: Person-Centered Health Care Reform, describes how such changes could save the federal government $300 billion over the next 10 years and more than $1 trillion over the next 20 years. Brookings finds that moving to patient-centered care is the ultimate means by which future cost savings can be achieved. For a specific example, the study proposes that Medicare should move away from the fee-for-service model and embrace comprehensive payment organizations.
Posted on April 26, 2013
A provision in the Affordable Care Act (ACA) incentivized state Medicaid agencies to design and develop new eligibility systems by offering a 90% federal reimbursement for the associated costs. A set of FAQ released by the Centers for Medicare and Medicaid Services (CMS) explains that state Medicaid programs will be eligible for an increased federal match rate of 75% for using and maintaining these upgraded eligibility system by January 1st, 2014. To qualify for the enhanced rate for the upgraded systems, states must meet operation and maintenance standards in the following categories:
- personnel costs
- software maintenance
- data entry
- computer operators
- coding clerks
States that choose not to expand their Medicaid program under the ACA will still be eligible for the increased reimbursement if they meet the specified upgrade requirements.
In addition to these stipulations, the FAQ also stated they would not authorize 1115 demonstration waivers that placed enrollment caps or periods of ineligibility for the new Medicaid-eligible adult groups under the ACA.
Posted on April 25, 2013
On April 9th, the Senate Finance Committee held a confirmation hearing for Marilyn Tavenner to be the Administrator of the Centers for Medicare and Medicaid Services (CMS). Committee members submitted additional questions to Tavenner post-hearing on topics ranging from consumer outreach in state insurance Exchanges to pediatric dental services. Health Reform GPS has compiled a list of the Affordable Care Act related questions submitted by the Senate Finance Committee members. The list contains the name of the Senator asking the question, the question number, and the relevant ACA topic addressed.
Posted on April 16, 2013
The State Health Reform Assistance Network, in conjunction with the National Academy of State Health Policy and the Robert Wood Johnson Foundation, released a checklist detailing Medicaid requirements that each state must meet by 2014, irrespective of whether or not a state expands Medicaid eligibility as described in the Affordable Care Act (ACA). To accompany the outlined requirements and optional provisions detailed in the report, State Health Reform Assistance Network has also included a resource list with tools and analyses that can be incorporated to aid in Medicaid requirement implementation. The checklist is divided into five categories that should be altered in response to pending Medicaid changes, each of which containing various requirements to satisfy the specified category:
- Eligibility and Enrollment
- Medicaid Operations
- Medicaid Financing
- Medicaid Benefits
- Consumer Assistance