Countdown to Coverage: Important Medicaid Changes, Even Without Expansion

Anne Dunkelberg

Despite Texas elected officials’ current—and regrettable!—decision to exclude the poorest uninsured adult Texans from coverage in 2014, there are some important Medicaid changes afoot here for 2014.  In fact, all 50 states are making these changes, no matter what their current decision on adult Medicaid expansion.  Texas Health and Human Services Commission’s staff certainly know it; they have put in plenty of long hours over the last year planning and prepping for these changes.

Here are some of the big-picture changes for 2014:

  • There will be a single application (paper, phone, or online) that can be used in every state to apply for Medicaid, CHIP (Children’s Health Insurance Program), or to get lower-cost coverage in the individual Health Insurance Marketplace.  (Compare today:  50 states, 50 different applications.)  States can also customize their own application (with federal approval), but must accept both the federal and the state version.
  • All 50 states will use the same income counting rules.  The new rules are generally based on how the IRS figures “adjusted gross income” for federal income taxes, but with some adjustments that are designed to protect current Medicaid coverage.  For example, income of grandparents or other non-parent relatives who are raising children will remain uncounted when determining Medicaid eligibility for those children—even if the children are treated as dependents on their grandparents’ tax return.
  • “Asset tests” will end for Medicaid children, parents, pregnant women, and CHIP kids.  Looking beyond income to tally up not only money in the bank but also the value of possessions and vehicles will end in 2014.  All but four states had already dropped these “resource tests” for children, but Texas still used them and over half the states still applied them to parents seeking Medicaid. (Note:  Medicaid for seniors and persons with disabilities, based on Social Security Administration law and rules, will still look at assets when applying for medical care and long term care benefits.)
  • Face-to-face interviews to apply or renew will no longer be required.   Almost all states have already dropped mandatory in-person application and renewal interviews for children’s and parent’s Medicaid and CHIP, and in 2014 all states will retire those requirements.  Importantly, though, in-person and telephone application assistance will remain an option in every state for those who prefer it.  (Note: Medicaid for seniors and persons with disabilities, based on Social Security Administration law and rules, may still require interviews.)
  • Electronic Verification tools will be used to the greatest possible degree.  Medicaid,  CHIP, and the new Health Insurance Marketplace are all expected to rely on electronic databases (employer/wage, new hire, Social Security, IRS, vital statistics, etc.) to the maximum degree possible to verify eligibility criteria for health care benefits( e.g. income, residence, citizenship, and immigration status).  It is likely that families with lots of monthly variation in hours of work and dollars earned will still face additional paper documentation requirements.  Still, many families will be able to avoid having to collect and submit numerous documents, and a growing percentage will have their eligibility determined in “real time.”
  • Former Texas Foster Children will be eligible for Medicaid until they turn 26.  Because the ACA allows young adults to stay on their parents’ health plan until age 26, Congress tried to create a parallel opportunity for youth “aging out” of foster care who would not otherwise have the same chance for coverage.
  • Medicaid renewal will be required only once every 12 months.  Children, parents, and adults without dependent kids (in the states that have expanded coverage to adults) will only have to renew eligibility once a year.  Importantly, there is a difference between a 12-month renewal period and 12-month “continuous” eligibility; the latter means persons need not report income changes during the 12-month period.  States like Texas that do not offer 12 months of continuous eligibility for children in Medicaid (we provide 6 months), and which have no continuous coverage for the small number of parents we cover on Medicaid, will likely still require families to report changes in income that occur during the 12-month period—at least in the near term.
  • CHIP kids 6-18 from 100-138 percent FPL will move to Medicaid.  Texas and most states have had a perplexing stair-step eligibility set up for children, leaving some families with preschool-aged kids in Medicaid while their school-aged kids in CHIP.  In 2014, most of the stair-step will be removed, so that all kids (age 1 through 18) with family incomes under 138 percent of the federal poverty level (FPL) will enroll in Medicaid, and those from 138-200 percent FPL will get CHIP coverage.  Texas plans to re-sort the currently enrolled CHIP kids when they first come up for renewal in 2014. (Note:  infants up to their first birthday will still be covered in Medicaid up to 185 percent FPL, the same income cap that applies for women’s maternity coverage.)

To get involved and stay informed on developments in the Medicaid-CHIP eligibility system, and its interface with the new Health Insurance Marketplace, join the Texas CHIP Coalition.

Written by: Anne Dunkelberg, Center for Public Policy Priorities. Cross-posted from the Better Texas blog.

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