Medicaid Readiness for 2014: Compliance Requirements and State Options

1. Getting Medicaid Ready for 2014: Federal Requirements and State Options September 24, 2010 Jocelyn Guyer

2. 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

3. 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.

4. 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”

5. “No Wrong Door” Enrollment System

6. “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

7. 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

8. 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

9. 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

10. 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

11. Verification Requirements State responsibilities for verification: • Verify selected elements of eligibility • Address inconsistencies and allow people to correct information

12. Use of Tax Data to Verify Income

13. Key Options for Texas

14. Decide Whether Medicaid Will Take Responsibility for Subsidy Determinations

15. 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

16. Conclusion Major transformation is coming: • No wrong door enrollment • Online, streamlined application process • Use of electronic data exchange to verify information

17. 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

18. 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/

19. 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