Medicaid Expansions

In this recent release, CMS proposes the methodology and data sources necessary to determine federal payment amounts made to states that elect to establish a Basic Health Program (BHP). The BHP program, which is scheduled to begin in January 2015, will offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through the health insurance marketplaces. Comments on the proposed funding methodology are due by January 22, 2014.

In June 2012, Medicaid enrollment reached 54.1 million as high unemployment and falling incomes led many families to turn to Medicaid for coverage. However, as economic conditions improved, enrollment growth in Medicaid slowed. An additional 1.3 million people enrolled in Medicaid between June 2011 and June 2012 (a growth rate of 2.5 percent) compared to the program’s most recent peak at the height of the recessionary period, where nearly 3.5 million additional people enrolled each period (growth rates of 7.8 and 7.2 percent). The issue brief provides further analysis of enrollment trends across all 50 states and DC as well as within select eligibility groups such as families, the aged and disabled, as well as adult expansions of non-disabled, non-elderly adults.

The final rule reducing Medicaid disproportionate share hospital (DSH) payments had few changes from the proposed rule. It cuts $500 million in fiscal 2014 and $600 million in fiscal 2015 allotments. The rule also defines the five factors that will be considered to generate a state-specific reduction allotment amount and establishes additional reporting requirements for the new DSH methodology.

This set of FAQs provides additional clarification on strategies for administering telephonic Medicaid and CHIP applications, how states should handle eligibility renewals in 2014, and who will receive the 75 percent match in eligibility systems. It also provides guidance on MAGI-based eligibility and transitioning children between 100-133 percent of the FPL from CHIP to Medicaid.

This rule finalized a slew of regulations related to the structure and operations of Medicaid, CHIP, and exchanges under the ACA. These include eligibility and enrollment requirements for qualified health plans and insurance affordability programs (Medicaid, CHIP, APTCs, and Basic Health Plans). It also detailed minimum standard requirements for Alternative Benefit Plans and changes to eligibility notices and appeals for Medicaid and CHIP. Additionally, it updated the criteria for verification of eligibility and enrollment in employer-sponsored insurance.