HHS Issues Final Rule on Medicaid Expansion Under PPACA

HHS has issued the final rule (pdf) on the expansion of Medicaid and the Children's Health Insurance Program under the Patient Protection and Affordable Care Act.

According to the rule, individuals aged 19 to 64 with incomes at or below 133 percent of the federal poverty level (in 2012, $14,856 for an individual and $30,656 for a family of four) will be eligible for Medicaid beginning Jan. 1, 2014. Low-income, childless adults will be guaranteed Medicaid coverage without the need for a waiver, and parents of children will be eligible at a uniform income level across all states. In addition, the federal government will provide 100 percent funding for newly eligible individuals for 2014 to 2016 and will gradually reduce funding to 90 percent for 2020 and beyond. HHS said in the rule that the increased federal funding will result in savings for individual states.

The final rule also simplifies eligibility and enrollment for Medicaid and CHIP. Financial eligibility will be determined by a single "Modified Adjusted Gross Income" standard, and eligibility categories will be consolidated into four groups: adults, children, parents and pregnant women. Electronic data and a federal data services "hub" will also simplify the verification procedures.

In addition, the final rule allows health insurance exchanges to perform Medicaid-eligibility evaluations. For example, exchanges can determine Medicaid eligibility based on a state's Medicaid eligibility rules, or exchanges can make a preliminary Medicaid eligibility assessment and then rely on the state Medicaid and CHIP agencies to make a final determination.

Certain provisions of the final rule are being issued on an interim final basis, allowing for comments on those provisions within 45 days. Provisions issued as interim final include those on safeguarding information on applicants and beneficiaries, timeliness and performance standards for Medicaid, coordinated eligibility and enrollment among CHIP and other insurance affordability programs and timeliness standards for CHIP.

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