Exploring the Challenges of Enrolling People into Medicaid and Premium Tax Credits January Angeles The William P. Hobby Policy Conference September 25, 2010

Benchmark benefit package Need to distinguish between previously vs. newly eligible Among newly eligible, need to identify those exempt from benchmark Needs to be an upfront determination because of impact on services people get Medicaid Enrollment Challenges

Changes in eligibility procedures Elimination of asset test and income disregards Use of Modified Adjusted Gross Income (MAGI) What income Whose income and household composition But retention of current procedures for some eligibility categories Medicaid Enrollment Challenges

State capacity for expansion Potential enrollment of 1.8 million new adults 1 in Texas Funding for IT system upgrades State workforce capacity Medicaid Enrollment Challenges 1 Estimates from the Urban Institute

Components of Eligibility Determination MedicaidCHIPPremium Credits Income  MAGI – 133% adults; higher for children and parents as needed to meet MOE  Existing Medicaid rules for people with disabilities, >65)  MAGI – varies by state  MAGI – 133 to 400% (<133% for legal immigrants subject to 5-year bar Timing of Income  Current  Prior tax year with exceptions for changed circumstances Citizenship or legal immigrant status  Must be citizen or “qualified alien” residing in U.S. > 5 years  Exceptions for lawfully residing children and pregnant women at state option)  Same as Medicaid  Citizen or lawfully residing Offer of employer coverage  Is premium assistance required?  Waiting periods for children with previous coverage  Exceptions to applicability that vary by state  Ineligible if have offer of ESI  Exceptions for those whose premium contribution > 9.5% of income Other  Disability  Pregnancy  Status as foster child  Age  Pregnancy  Prior coverage  Age  Existence of minimum essential coverage

Key differences between Medicaid/CHIP and premium credits Presence of other coverage Timing of income information Non-MAGI populations in Medicaid Medicaid/CHIP & Premium Credit Coordination Challenges

Major changes needed to conform to new Medicaid rules and coordinate with premium credits Complex issues, but solutions exist One entity to handle eligibility determinations Strong IT systems and “back room” processes to effectively deal with differences Looking Ahead: Implications for Eligibility Systems