Exploring the Challenges of Enrolling People into Medicaid

and Premium Tax CreditsJanuary Angeles

The William P. Hobby Policy ConferenceSeptember 25, 2010

Benchmark benefit package• Need to distinguish between previously vs. newly eligible

• Among newly eligible, need to identify those exempt from benchmark

• Needs to be an upfront determination because of impact on services people get

Medicaid Enrollment Challenges

Changes in eligibility procedures• Elimination of asset test and income disregards

• Use of Modified Adjusted Gross Income (MAGI)

• What income

• Whose income and household composition

• But retention of current procedures for some eligibility categories

Medicaid Enrollment Challenges

State capacity for expansion• Potential enrollment of 1.8 million new adults1 in Texas

• Funding for IT system upgrades

• State workforce capacity

Medicaid Enrollment Challenges

1 Estimates from the Urban Institute

Components of Eligibility Determination

Medicaid CHIP Premium Credits

Income MAGI – 133% adults; higher for children and parents as needed to meet MOE Existing Medicaid rules for people with disabilities, >65)

MAGI – varies by state MAGI – 133 to 400% (<133% for legal immigrants subject to 5-year bar

Timing of Income

Current Current Prior tax year with exceptions for changed circumstances

Citizenship or legal immigrant status

Must be citizen or “qualified alien” residing in U.S. > 5 years Exceptions for lawfully residing children and pregnant women at state option)

Same as Medicaid Citizen or lawfully residing

Offer of employer coverage

Is premium assistance required?

Waiting periods for children with previous coverage Exceptions to applicability that vary by state

Ineligible if have offer of ESI Exceptions for those whose premium contribution > 9.5% of income

Other Disability Pregnancy Status as foster child Age

Age Pregnancy Prior coverage

Age Existence of minimum essential coverage

Key differences between Medicaid/CHIP and premium credits

• Presence of other coverage

• Timing of income information

• Non-MAGI populations in Medicaid

Medicaid/CHIP & Premium Credit Coordination Challenges

• Major changes needed to conform to new Medicaid rules and coordinate with premium credits

• Complex issues, but solutions exist• One entity to handle eligibility determinations

• Strong IT systems and “back room” processes to effectively deal with differences

Looking Ahead: Implications for Eligibility Systems