CRS report says states cannot yet change Medicaid eligibility
Posted on July 19, 2012 | Comments (2)
The Congressional Research Services (CRS) published a memo saying that states cannot change Medicaid eligibility before 2014. The Affordable Care Act (ACA) requires states to maintain 2009 Medicaid eligibility standards through 2014 as part of the maintenance of effort provision. The purpose of this effort is to stop states from limiting eligibility until the federal government reimbursement increases take effect in 2014.
The Supreme Court’s June 28th ruling on Medicaid expansion caused many leaders to call into question the ACA’s maintenance of effort provision. The CRS report confirms that the ruling does not free governors to modify current Medicaid eligibility rules. The Obama administration has made similar arguments in letters to governors, saying that the Supreme Court ruling only affected Medicaid expansion and did not carry over into other provisions such as maintenance of effort.
The CRS report was less clear regarding whether states can choose to expand Medicaid after 2014. The report said that Health and Human Services Secretary Kathleen Sebelius could decide that states must join the expansion by 2014, noting, however that a state could argue that if it meets the health care law’s Medicaid requirements at a later date, the federal government must support them. The report also said that it is unclear if states can choose to cover some, but not all, of the newly eligible group of Medicaid beneficiaries.
- The rule provided additional information regarding the administration's decision to delay the employer shared responsibility requirement. In order to determine if an individual is eligible for federal subsidies, the Exchange must be aware as to whether or not the individual has access to affordable health insurance from his or her employer. As a result of the delay, the Exchange will have no comprehensive database or official records reporting if an individual has access to affordable coverage, and thereby determine subsidy eligibility. The Exchange will therefore rely upon applicant self-reported information, verification against other information sources such as tax returns, and sampling of a group of applicants in which the Exchange will manually call the applicant's employer.
- Individuals who are deemed eligible for a subsidy based upon their applications will receive subsidies during the time in which their eligibility review is being conducted. The audit period is reported to last for 90 days.
- CMS outlined how the Exchange should coordinate with state Medicaid and CHIP officials to determine who is eligible for these programs.
- The rule also describes key provisions of the Alternative Benefits Plan, Medicaid's benchmark plan for states that expanded Medicaid. In addition, the rule updates the cost-sharing and premium regulations for Medicaid plans. Specifically, states are now permitted to charge higher cost-sharing for prescription drugs and non-urgent visits to the emergency room.
- CMS clarified that cost-sharing of plans offered on the Exchange must be considered in determining whether or not it would be cost effective to offer this plan to Medicaid beneficiaries through the premium assistance model.
- personnel costs
- software maintenance
- data entry
- computer operators
- coding clerks
- Eligibility and Enrollment
- Medicaid Operations
- Medicaid Financing
- Medicaid Benefits
- Consumer Assistance