Medicaid Expansion: States' Implementation of the Patient Protection and Affordable Care ACT: Gao-12-821
Synopsis "Medicaid Expansion: States' Implementation of the Patient Protection and Affordable Care ACT: Gao-12-821"
Under PPACA, states are responsible for making a number of changes to their Medicaid programs by January 1, 2014, including expanding eligibility levels and streamlining their enrollment processes. Specifically, states must expand Medicaid eligibility to non-elderly individuals with incomes at or below 133 percent of FPL. Under the newly eligible category, states will provide Medicaid coverage to eligible low-income parents and childless adults. States must also begin determining income eligibility for Medicaid beneficiaries, including newly eligible adults, using a uniform methodology-MAGI, which is a tax-based definition of income. To implement these requirements, eligibility categories have been consolidated into four groups-adults, children, parents, and pregnant women. States may choose to expand Medicaid coverage to the newly eligible prior to January 1, 2014 (referred to as the early expansion option), but must cover lower income individuals before higher income individuals. These more uniform eligibility requirements will replace the current system where Medicaid eligibility and income rules may vary from state to state. Further, states must adopt a methodology for identifying the newly eligible in order to obtain the increased federal match. States will receive the enhanced federal match for newly eligible adults starting in 2014. States must also provide a simplified and streamlined eligibility process whereby individuals, through a website, may apply for and, if eligible, be enrolled in Medicaid. In addition, state eligibility determination systems will interface with a Federal Data Services Hub-an electronic service states will use to verify certain information with other federal agencies, such as an applicant's citizenship, immigration status, and income data.
