February 24, 2016

A Plethora of Medicaid News!

Detailed State-by-State Medicaid and CHIP Information

The Kaiser Family Foundation has issued its latest 50-state survey on Medicaid and CHIP policies, Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies as of January 2016: Findings from a 50-State Survey. (It also includes information on the District of Columbia.) Tables accompanying the report cover a multitude of policies, including Trends in State Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies, July 2000 to January 2015; Upper Income Eligibility Limits for Children's Health Coverage as a Percent of the Federal Poverty Level (FPL); Waiting Periods for CHIP Enrollment; Optional Medicaid and CHIP Coverage for Children; Medicaid and CHIP Coverage for Pregnant Women; MAGI Eligibility Systems; and Coordination between Medicaid and Marketplace Systems.


CMS Releases State-by-State Designations of Whether Certain Medicaid Categories Meet Minimum Essential Coverage Standards

As explained in this blog post from the Georgetown Center on Children and Families, CMS has issued a long-awaited assessment of whether certain Medicaid coverage categories in each state - including section 1115 waivers - meet minimum essential coverage (MEC) standards. This list is important because:

  • Individuals eligible for non-MEC Medicaid can qualify for premium tax credits and cost-sharing reductions.
  • Individuals with non-MEC Medicaid coverage know whether they need to secure MEC to avoid the penalty or need to file an exemption application.

Generally individuals are not eligible to receive premium tax credits if they are considered eligible for MEC, such as Medicaid and CHIP. But certain Medicaid coverage categories are not considered MEC. Coverage for low-income pregnant women, "medically-needy" individuals, and individuals covered under some waiver programs may or may not meet MEC standards, depending on the state. Further, individuals who are eligible for non-MEC Medicaid are considered uninsured for ACA purposes, and therefore could be subject to the individual mandate and tax penalty if they are not otherwise exempt. However, CMS has taken care of this by specifying that individuals who are eligible for specific non-MEC Medicaid categories (pregnant women's coverage, coverage under the CHIP unborn child option, and spend-down programs) will qualify for a hardship exemption and are therefore not subject to a tax penalty.


It is important to note that neither the hardship exemption types posted on healthcare.gov nor the hardship exemption application explicitly lists non-MEC Medicaid eligibility as a qualifying reason not to have health insurance. Individuals who qualify for the exemption should apply based on the directions for #14 - other hardship - unless the website and application are updated.


Alabama Puts Hospitals At Forefront Of Medicaid Managed Care. This article discusses the unusual Medicaid managed care model being used by Alabama.


Iowa Senate OKs Bill to Dismantle Medicaid Privatization. This article discusses some legislators' concerns about moving Medicaid patients into private managed care programs in Iowa. The bill that passed the Senate is not likely to become law, but Senate Democrats have also introduced legislation that would establish state monitoring of the program to ensure the transition is working and other bills related to the new Medicaid implementation. Their chances of enactment are also unclear. Senate Democrats also recently sent a letter to federal officials asking them to end the privatization move.


Does Medicaid Mean Poorer Care? This article discusses a study that found that Medicaid may be the best insurance coverage for children. Researchers found that children who received care through Medicaid had better medical preventive and dental coverage, fewer out-of-pocket costs, and no more trouble accessing care than children who received care through private insurance.

However, researchers also found that in each payer group, there were challenges in accessing specialty care - as many as 1 in 4 children had difficulty seeing a specialist. The challenges were even greater for children insured under the CHIP program and privately insured children with special healthcare needs - 28% and 29%, respectively, reported having problems seeing a specialist.