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DMA Update. Division of Medical Assistance July 2013. ACA Impact. Will affect most Family & Children’s Medicaid programs and NCHC Budgeting methodology will totally change Coverage for groups will remain the same

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dma update

DMA Update

Division of Medical Assistance

July 2013

aca impact
ACA Impact
  • Will affect most Family & Children’s Medicaid programs and NCHC
  • Budgeting methodology will totally change
  • Coverage for groups will remain the same
  • Children on NCHC, age 6-18, whose income is less than 133% fpl (or new converted amount) will move to Medicaid
  • Former NC foster care children up to age 26 will have coverage without regard to income
    • Current expanded foster care is different group under different federal regulations
what is magi
What is MAGI?
  • Modified Adjusted Gross Income – term used in income tax and adjusted for certain items per ACA
  • Is budgeting methodology, not just an amount
  • Will utilize tax household concept in most cases
  • No longer allow disregards and deductions allowed today, such as earned income disregard, child care, etc.
  • Current Income limits are converted to MAGI equivalent numbers to account for not allowing disregards
    • For example: MPW is currently 185% fpl – this could change to 196% - (still finalizing the numbers)
magi cont d
MAGI, cont’d
  • No longer count child support, but continue to count spousal support
  • SSA is normally non-countable, but Congress amended law to include SSA
  • Income of children and other tax dependents in household may not be countable unless they file or plan to file tax return
  • For all individuals, must now ask if they file or plan to file tax return, and if they will be claimed as tax dependent by someone else
magi cont d1
MAGI, cont’d
  • Constructing household for each individual will be very similar to process of determining au, bu, nu for F&C
    • Will need to set aside what you think will happen and work through the steps
      • Is not limited to spouse for spouse and parent for child
    • Household may be very different from current policy
  • No resource limit/test for MAGI groups (MAF)
presumptive eligibility hospitals
Presumptive Eligibility – Hospitals
  • Hospitals may opt to do presumptive eligibility for most MAGI groups
    • Must develop policy for hospitals on presumptive
  • State must provide training and set qualifications
  • State must set thresholds, such as % of individuals who file apps by deadline, % of individuals who are eligible for Medicaid
  • Will not otherwise expand presumptive at this time
presumptive eligibility hospitals1
Presumptive Eligibility - Hospitals
  • Presumptive for pregnant women still limited to ambulatory prenatal care
  • For programs other than pregnant woman, coverage determined by program category (FPW, MIC, etc)

Federal Contact Center Inquiries

  • June – September 2013:
  • –The contact center will launch in conjunction with the new look and feel of
  • –The contact center will respond to general inquiries about the program, educational, primarily related to:
  • •Health Insurance (“What’s a premium?” “What’s a deductible?”)
  • •Program (“I have insurance, will I be impacted?”)
  • •Preparation (“Where can I go to get additional information?” “When will I need to make a decision?)
  • •October 2013 – March 2014 :
  • –The contact center will assist with completing an enrollment application and eligibility determination, performing a plan compare to assist callers with selecting their insurance options, addressing issues related to premium information (based on adjusted gross income), determining tax credit eligibility, and issuers complaints.
  • •January 2014 – beyond:
  • –The contact center will be available to assist with additional questions as coverage begins such as income adjustments, referrals and complaints to the insurance plans
assessing eligibility ffm
Assessing Eligibility - FFM
  • NC has opted for the FFM to assess eligibility for Medicaid/NCHC, not determine eligibility
  • NC is sending eligibility information to the FFM so they can program our converted income limits, programs, and options
  • FFM will use NC info to screen for Medicaid/NCHC eligibility
  • If appears eligible, FFM will transfer account to NC
  • If appears ineligible for MA/NCHC, FFM will transfer if individual requests full Medicaid determination
    • May still enroll in APTC or reduced cost sharing, if eligible, while Medicaid determination made (disability, deductible, etc)


Stay tuned for lots more information/policy in the next couple of months!!!