1. MEDICAID CHANGES UNDER PPACA George H. Ritter Wise Carter 401 E. Capitol Street Jackson, Mississippi 39201 (601) 968-5526

2. Major Components Medicaid expansion CHIP-related provisions DSH contraction Outreach and enrollment provisions

3. Medicaid Expansion Newly Eligibles – Non-elderly (under 65), non-pregnant individuals Not enrolled or entitled to be enrolled in Medicare Part A or enrolled in Medicare Part B Income is 133% or less of FPL Not otherwise eligible for Medicaid – Poverty-related children Raises income eligibility level from 100% of FPL to 133% FPL – Certain individuals with disabilities not currently eligible because— Do not meet SSI definition of disabled, or Have income or asset levels greater than state’s threshold

4. Funding for Newly Eligibles – Optional Phase-in Period 4/1/2010 thru 1/1/2014 State option No federal funding – Mandatory Period Beginning 1/1/2014 – 100% federal funding Beginning 2020 – Decreases to 90% federal funding

5. State Maintenance of Effort Requirements – Loss of FFP if eligibility standards, methodologies, or procedures are made more restrictive than they were as of 3/23/2010 Can’t balance budget by tightening eligibility standards – Exception for non-pregnant, non-disabled adults with AGI greater than 133% FPL Available between 1/1/2011 and 12/31/2013 Federal waiver required

6. New Benefits – Premium assistance (optional) – Birthing centers (mandatory) – Adult preventive care (mandatory and optional components) – Smoking cessation for pregnant women (mandatory) – Home and community based attendant care (optional) – Health homes for patients with certain chronic conditions (optional)

7. CHIP-Related Provisions Thru FY2015 – Current CHIP structure maintained FY2016 – FY2019 – 25% increase in federal CHIP match – Currently not appropriated – If not appropriated, coverage will be available through health insurance exchanges Childhood Obesity Demonstration Project – $25 billion for FY2010-FY2014 Many other details

8. DSH Contraction Beginning FY2014 – Medicare DSH payments reduced by approximately 75% ($22B over 10 years) – Medicaid DSH payments reduced from by approximately 50% ($14.1B over 10 years) – Hospitals may qualify for additional DSH payments based on several complex factors – Exact amounts cannot be determined, but reimbursements will decrease substantially if expanded coverage does not offset the DSH cuts – Additional limitations on judicial review

9. Outreach and Enrollment Provisions Internet website enrollment – No face to face meetings Coordination with health insurance exchanges – Exchanges screen applicants for Medicaid and CHIP eligibility – Medicaid screens applicants determined ineligible for eligibility in qualified plans through exchanges Required outreach for vulnerable populations – Unaccompanied homeless youth – Racial and ethnic minorities – Individuals with HIV/AIDS Presumptive eligibility determinations by hospitals – Extended to all Medicaid eligible populations (previously limited to certain groups) – During presumptive eligibility period, claims will not be reviewed for errors in the state’s eligibility determinations

10. Projected Impact Additional 16 million Medicaid beneficiaries – 27.4% increase Federal government will pay 95.4% of the increased cost UPL expected to increase based on increased enrollment Federal matching rate will be a combination of— – Current matching rates on current eligibles – Expansion state maximum rate for certain childless adults – Higher matching rates on newly eligibles

11. For more information Congressional Research Service, Medicaid and the State Children’s Health Insurance Program (CHIP) Provisions in PPACA, April 28, 2010 www.crs.gov