Medicaid Moving Forward 2014
As the improvements to the Medicaid and CHIP programs brought about by the Affordable Care Act take full effect, the information provided in this section outlines the results of the states’ implementation efforts to date. The following set of national tables describes key programmatic features related to eligibility and the enrollment process for health coverage in 2014. The tables provide Modified Adjusted Gross Income (MAGI)-based Medicaid and CHIP eligibility levels by state; the Marketplace model each state will be using in 2014; a description of the Medicaid/CHIP eligibility verification policies states are adopting; and a listing of the states that are employing new targeted enrollment strategies to smooth the path to Medicaid and CHIP coverage in 2014. This section also includes links to state-specific landing pages that lead to state-specific documents relating to each of these matters. Additional materials will be added to this section over the coming weeks and months as Medicaid moves forward into 2014.
Medicaid and CHIP Eligibility Levels (for MAGI Groups)
These tables depict the new MAGI-based eligibility levels that states will have in place for Medicaid and the Children’s Health Insurance Program (CHIP) beginning on January 1, 2014. The first table expresses these standards as a percentage of the federal poverty level (FPL); and the additional tables provide the eligibility levels in dollar amounts for annual income and calculated for a family size of one, two, three and four. See more information on Medicaid and CHIP MAGI eligibility levels for 2014.
Medicaid, CHIP and the Marketplace in 2014
This table highlights some of the critical intersections between the Marketplace, Medicaid, and CHIP. The table lists the Marketplace model each state has selected for 2014 – State-Based Marketplace, Federally-facilitated Marketplace (FFM), or working in partnership with the Federal Marketplace. Click here for more information about Medicaid/CHIP and Marketplace coordination.
Eligibility Verification Policies
This table depicts key elements of states’ approach to verifying the factors of eligibility for coverage in Medicaid and CHIP. The Affordable Care Act and accompanying federal regulations have established a modernized, data driven approach to verification of financial and non-financial information needed to determine Medicaid and CHIP and Marketplace eligibility in 2014. Click here for more information regarding states' eligibility verification policies.
Targeted Enrollment Strategies
In response to CMS guidance provided on May 17, 2013, (available at http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-13-003.pdf) many states have adopted one or more of the targeted enrollment strategies designed to facilitate enrollment of eligible individuals in Medicaid/CHIP. States can choose among 5 strategies identified. Click here for more information about targeted enrollment strategies.
Application and Enrollment in 2014
The Affordable Care Act establishes a streamlined enrollment process through which individuals can gain access to affordable insurance coverage for which they are eligible. The law directs the Secretary of HHS to develop a model application that will be used to apply for coverage through the Marketplace, Medicaid and the Children’s Health Insurance Program (CHIP). States have the option to adopt the Secretary of HHS’s model application form for affordable insurance programs or to adopt an alternative application that meets federal requirements. There is variation across states in the degree to which the alternative applications resemble the Secretary’s model and some states are continuing to modify their applications, but every state is offering a single application for the Marketplace, Medicaid and CHIP that will enable consumers to enroll in the coverage program that is appropriate for them. Not all states have their on-line applications ready for use on October 1st (for more information see each state’s “Consumer Experience Profile”). To view information about how to apply for Medicaid/CHIP coverage in each state, click here to go to the map linking to each state’s 2014 landing page.
Consumer Experience Profiles
The Consumer Experience Day 1 Profiles summarize each state’s application and enrollment process to date. The Profiles are designed to offer a high level overview for consumer assistance organizations and others who may be providing information to individuals about how to enroll in health coverage. The documents describe what form of application the state will have in place for enrollment in Medicaid, CHIP and the Marketplace and the venues through which individuals can apply. The profiles describe how the coordination between Medicaid, CHIP and the Marketplace will work and gives those who are assisting consumers a sense of what to expect in terms of application processing times and the role the Marketplace will play in assessing or determining Medicaid/CHIP eligibility in that state. The profiles will be updated as states’ systems capabilities evolve over the coming months. Select a state from the 50-state map to view the Day 1 Profiles.
Medicaid/CHIP Eligibility Verification Plans
New, modernized rules regarding verification of Medicaid and Children's Health Insurance Program (CHIP) eligibility will mean that state Medicaid and CHIP agencies will rely primarily on information available through data sources (e.g., the Social Security Administration, the Departments of Homeland Security and Labor) rather than paper documentation from families. Each state has prepared a verification plan for Medicaid and CHIP in order to comply with the new rules. To view each state's plan, select a state from the 50-state map.
MAGI Conversion Plans
CMS provided states with a template for completing their “MAGI Conversion Plans” that are designed to reflect the MAGI-based eligibility standards that will be in place in 2014. The MAGI-conversion process involved a translation of pre-2014 net income eligibility standards into MAGI-based eligibility standards. Moving to MAGI replaces income disregards with simpler, more universal income eligibility rules that are generally aligned with the rules that will be used to determine eligibility for the premium tax credits that will be available in the Marketplace. To complete the transformation to MAGI, states needed to “convert” their net-income based eligibility standards to MAGI-based standards. In addition, the new rules discontinue use of assets tests in determining Medicaid eligibility.
In December 2012, CMS provided three options to choose from in selecting a MAGI conversion methodology – for 1) CMS to perform the conversions on behalf of states using a standardized methodology based on the Survey of Income and Program Participation (SIPP), adjusted for each state’s demographic situation; 2) states to perform the conversion using the standardized methodology using state-generated data; or 3) states to propose an alternative conversion methodology based on state data. The converted standards set the minimum and the maximum eligibility levels for the specified group; states then identify their new income standards on their Medicaid and CHIP state plan amendments (SPAs), based on the converted levels provided in the approved MAGI conversion plans. Click here to view states’ approved MAGI conversion plans.
Medicaid/CHIP State Plan Amendments
The state Medicaid and CHIP plan spells out how each state has chosen to design its program within the broad requirements for federal funding. As always, states need to amend their Medicaid and CHIP state plans in order to secure legal authority and also federal financing for each of the approaches they adopt for enrolling and serving their beneficiaries. The 50-state map provides a link to each state’s 2014 related eligibility and alternative benefit plan SPAs that are needed to conform to the provisions of the Affordable Care Act. To view approved Medicaid and CHIP state plan amendments, select a state from the 50-state map. States are continuing to submit and CMS is continuing to review state plan amendments implementing the Affordable Care Act.
Monthly Medicaid and CHIP Reports
This page includes the monthly reports on State Medicaid and Children’s Health Insurance Program (CHIP) Performance Indicator data. State Medicaid and CHIP programs submit weekly and monthly data to CMS on a range of indicators related to application, eligibility, and enrollment processes.
These reports represents state Medicaid and CHIP agency eligibility activity for each calendar month beginning in October 2013. These reports coincide with the initial open enrollment period for the Health Insurance Marketplaces. The reports focus on those monthly indicators that relate to key processes relevant during open enrollment, including data on applications submitted and determinations made at the state level, that is, those applications submitted directly to Medicaid and CHIP agencies; applications submitted to Marketplaces that are operated by states; and Medicaid and CHIP eligibility determinations those entities have made. This data supplements data on Marketplace activity released by HHS in the Health Insurance Marketplace: Enrollment Report
Monthly Application and Eligibility Reports
- UPDATED: December Application and Eligibility Data (as of 2/28/2014) (NEW!)
- Medicaid & CHIP December 2013 Application and Eligibility Report (pdf)
- UPDATED: November Application and Eligibility Data (as of 1/22/2014)
- Medicaid & CHIP November Application and Eligibility Report (pdf)
- UPDATED: October Application and Eligibility Data (Updated as of 12/20/2013)
- Medicaid & CHIP October Monthly Application and Eligibility Report (pdf)