New Options for States: Facilitating Medicaid and CHIP Renewal & Enrollment in 2014

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 simplicity.

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 coverage.

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 facilitate enrollment.

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