States must prepare themselves for an efficient enrollment period in order to capitalize on the upcoming changes to Medicaid eligibility under the Affordable Care Act. The Centers for Medicare & Medicaid Services (CMS)/Center for Medicaid & CHIP Services, recently released a letter that identifies enrollment strategies to help with the anticipated increase in applications. These optional strategies may facilitate enrollment while lessening administrative demands on individual states.
Here are the strategies for those states
interested in adopting them:
1) Implementing the early adoption of
Modified-Adjusted Gross Income, (MAGI)-based rules
Under the ACA, eligibility for all health
insurance programs will be determined by MAGI methodology, which uses different
income-counting procedures than current Medicaid programs. During the open
enrollment period, which begins on October 1st, 2013, individuals applying for
coverage in 2013 will determine their eligibility through MAGI methodology.
However, individuals renewing and applying for Medicaid during that 4-month
period will have their income reviewed by both current rule and MAGI
methodology. States can opt to change how they determine eligibility starting
October 1st in order to simplify this process.
2) Extending the Medicaid renewal period
Anyone who has a Medicaid renewal
which falls in the first quarter of 2013 will also have to have their
eligibility determined by both pre-MAGI and MAGI rules. Extending the renewal
period will allow the states to use only the MAGI eligibility rules for
3) Enrolling individuals into Medicaid based on
Supplemental Nutrition Assistance Program, (SNAP), eligibility
The majority of non-elderly, non-disabled
individuals who receive SNAP benefits are also eligible for Medicaid. Enrolling
individuals in Medicaid who also receive SNAP benefits without a separate,
MAGI-based income determination can help ease a state’s administrative burden.
This enrollment opportunity can be implemented for a limited amount of time as
states handle the demands of the increase in applications.
4) Enrolling parents into Medicaid based on
their children’s Medicaid eligibility
A large number of parents with Medicaid-eligible
children will also be eligible for Medicaid when changes go into effect.
Enrolling parents based on their children’s eligibility can also serve as a
temporary way to facilitate enrollment.
5) Adopting 12 month continuous-eligibility for
parents and other adults
Many states already have 12-month
continuous-eligibility for children, meaning that children are guaranteed their
Medicaid coverage for a full year despite changes to their family’s income.
Extending this guarantee to families will reduce the amount of “churning”
between different plans, and ensure that entire families have more consistent
States that wish to implement any of these
strategies must get authorization from the federal government. CMS also is
encouraging states to propose any other creative strategy that will
Illinois should consider whether some or
all of these options are optimal. Implementing these
strategies could lessen the administrative burden on the state, maximize
enrollment of uninsured populations, maximize eligibility for low income
families, and increase federal financing for health care in the state.
Stephanie Altman & Kathryn Bailey
Health & Disability Advocates