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Sep, 2011
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Update: Medicaid Program Eligibility Changes under the Affordable Care Act


by: Sara Rosenbaum


This update to the Medicaid Implementation and health insurance Exchange Briefs reviews a Notice of Proposed Rulemaking (NPRM) implementing the Medicaid and CHIP eligibility, enrollment simplification, and coordination provisions of the Affordable Care Act. Issued by the United States Department of Health and Human Services on August 17, 2011, [1] the rule is comprehensive in scope; its public comment period ends October 31, 2011.

The Medicaid NPRM is part of a group of three regulations, [2] all of which are summarized at healthreformGPS.orgTogether the rules are designed to implement both the Medicaid eligibility expansions, the process of determining eligibility for premium tax credits and cost sharing assistance in the Exchange individual market, and standards for employers purchasing coverage in Exchanges. Collectively, the rules are designed to allow individuals and families to acquire and keep coverage and move more seamlessly among publicly-supported sources of health insurance as family income and circumstances change.

The Medicaid NPRM implements the ACA’s Medicaid eligibility expansions as well as its simplified enrollment and retention procedures. The proposed rule also makes changes in pre-existing Medicaid eligibility, enrollment, and retention standards in order to simplify state plan administration while better aligning state Medicaid and Exchange practices. Thus, the rule addresses reforms aimed at not only expanding Medicaid coverage but improving performance for all beneficiaries. The integration of Medicaid and Exchange functions is crucial given the large number of individuals and families who can be expected to move across the Medicaid and Exchange markets as financial and family circumstances change.[3]

To read the full report click here.