News

The Center for Healthcare Research & Transformation (CHRT) released a policy paper that shows how the Patient Protection and Affordable Care Act (ACA) in 2014 will streamline eligibility categories and may also help between 400,000 and 500,000 citizens to become newly eligible for Medicaid coverage. Currently, there are at least 40 different ways—each with varying eligibility requirements—to qualify for Medicaid in Michigan.

Whether or not Michigan decides to expand coverage for Medicaid, the paper shows that enrolling in Medicaid and maintaining that coverage should become easier for Michigan residents starting in 2014, when the ACA requires states to eliminate asset tests—a review of an individual’s assets to ensure they do not exceed certain limits—and consolidate existing eligibility categories.

“Many changes were included in the ACA that go beyond the Medicaid expansion. These changes were designed to make enrollment policies and processes simpler for those who have existing Medicaid coverage, and enable those newly eligible to go through an easier enrollment process than exists today. These enrollment changes alone should help ensure that more people have access to the affordable care when they need it,” says Marianne Udow-Phillips, CHRT’s director.

Under current federal rules, the Medicaid program provides coverage to those at or below a certain income level who also fit within certain categories, and states can opt to expand Medicaid eligibility.

In 2014, all existing eligibility categories—mandated or optional—will be simplified and consolidated into three categories:

• Parents and caretaker relatives of dependent children under 19.
• Pregnant women.
• Infants and children under age 19.

Additionally, those who receive Supplemental Security Income (SSI) or qualify as “medically needy” will remain Medicaid eligible to avoid gaps in coverage.

For states that opt to expand Medicaid, all non-elderly citizens and eligible resident immigrants with incomes at or below 138 percent⁽¹⁾Under the ACA, the first 5 percent of income is not counted. The practical effect of this income “disregard” is to make the eligibility threshold 138 of poverty. of the federal poverty level will become Medicaid eligible, even if they are not categorically eligible.

While the Medicaid expansion is optional for states, streamlining eligibility criteria and simplifying enrollment processes is still required.

“Today’s Medicaid system is complex, with wide variation in eligibility requirements among categories. The Affordable Care Act will streamline this process to make it easier for those uninsured to receive and keep coverage,” says Udow-Phillips.