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

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

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” YearEnhanced Matching Rates for Newly Eligible Adults % % % % % % 2020 and after 90% 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,

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”

“No Wrong Door” Enrollment System

“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

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

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

Information State Will Need ①Name, address, date of birth ②SSN (if lawful immigrant, additional information) ③Employer coverage information ④Income/family size from prior tax year ⑤Additional information to determine Medicaid or CHIP eligibility (further guidance needed) ⑥If applicable, reason for claiming a mandate exemption

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

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

Use of Tax Data to Verify Income File 2012 taxes April 2013 Apply for coverage 2013 Enroll in and use coverage 2014 Reconcile and adjust April 2015

Key Options for Texas

Decide Whether Medicaid Will Take Responsibility for Subsidy Determinations Medicaid has extensive experience Single, unified entity to evaluate subsidy, Medicaid and CHIP eligibility Easier to maintain linkages between health and other low-income programs On the one hand, Medicaid may not be ready to take on this additional responsibility by 2014 Computer system issues Some argue to separate health programs from other low-income programs On the other hand,

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

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

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

For more information Jocelyn Guyer Our website: Say Ahhh! Our child health policy blog:

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