state legislatures may change medicaid eligibility requirementsstate legislatures may change medicaid eligibility requirements

One should also be aware that eligibility requirements and available programs differ based on the state in which one resides. State: Alternative Name: Alabama: Alaska: DenaliCare: Additional states are likely to attempt to adopt expansion through ballot initiatives in 2020. While current rules require states to act when enrollees report a change in circumstances that may affect their continued eligibility, the Trump Administration has encouraged use of periodic eligibility checks as a program integrity strategy and has encouraged states to conduct enhanced eligibility verification and more closely monitor changes in enrollee circumstances. The standard legislative process has also worked in some states where adopting the Medicaid expansion was initially supported by one branch but not the other. Also enroll in MSP group if eligible. The Trump Administration released a waiver template for COVID-19 related changes that were primarily focused on allowing states to adopt certain LTSS policies, and approvals to date have been related to requests made under the template. Former Republican Governor Corbett negotiated a Section 1115 waiver to implement the Medicaid expansion with CMS that was approved in August 2014, and implemented on January 1, 2015.22,23 Former Independent Governor Walker of Alaska took a similar approach after he was unable to persuade the Alaska Legislature to adopt the expansion in early 2015 (he took office in December 2014). The new law effectively prohibits the Wisconsin governor from expanding Medicaid without some involvement from the Legislature.36,37 On January 8, 2019, Governor Evers signed an executive order directing the Department of Health Services to develop a plan to expand Medicaid;38 however, Republican leaders in the Legislature signaled that the Legislature would be unwilling to support it.39, Multiple states have adopted the Medicaid expansion through a ballot initiative. We call this waiver the Medicaid Transformation Project (MTP), and the MTP renewal "MTP 2.0." MTP 2.0 begins July 1, 2023. State legislatures may change Medicaid eligibility requirements a. as directed by the federal government. However, Corbett was defeated in the November 2014 election by current Democratic Governor Wolf, who transitioned Pennsylvanias Medicaid expansion from a waiver program to a traditional (SPA) expansion program shortly after taking office on January 20, 2015.65 Conversely, Kentucky initially adopted the expansion through executive action and a SPA under former Democratic Governor Beshear, but following the election of Republican Governor Bevin, Kentucky has attained CMS approval for a Section 1115 waiver expansion program with new restrictions on expansion coverage (the state intends to implement the waiver later in 2019, however, litigation over the waiver is ongoing).66 Louisianas Medicaid expansion experience presents another example of the impact of elections. State legislatures may change Medicaid eligibility requirements a. as directed by the federal. The letter also requests clear guidance for states for returning to normal in a manner that best protects and minimizes disruption for Medicaid beneficiaries, providers, plans, and states. Although federal rules specify certain requirements related to renewals and periodic eligibility verifications, states will be looking for additional guidance from CMS about rules related to processing renewals and redeterminations when the PHE ends. The California Department of Industrial Relations, established in 1927, protects and improves the health, safety, and economic well-being of over 18 million wage earners, and helps their employers comply with state labor laws.DIR is housed within the Labor & Workforce Development Agency States have flexibility to expand eligibility or modify eligibility rules, eliminate or waive premiums, and streamline application and enrollment processes. And as seen in states like Missouri, Virginia, and Florida, state legislators also have the power to stop Medicaid expansion in its tracks. Jennifer Tolbert , and Other targeted legislative bi-partisan legislative proposals include the Medicaid Reentry Act (included in the House passed COVID-relief package) would allow Medicaid to cover services for Medicaid beneficiaries who are incarcerated during the 30 days preceding their release from prison or jail which could facilitate coverage and access post-release. CMS is encouraging states to conduct renewals and redeterminations to the extent possible during the PHE and plans to issue more specific guidance later about the end of the PHE.21 This guidance could include more specific instructions to states about policies and processes for addressing redetermination and renewal backlogs that may have accumulated during the PHE, when data matches for income must be conducted, when to determine current income (for example, when states must conduct another updated eligibility determination to check for subsequent changes in circumstances for individuals who maintained eligibility only due to the MOE), and what notices will be required when the PHE ends. The federal share is gradually phasing down to 90% in 2020 (where it will remain in later years), still well above traditional federal medical assistance percentage (FMAP) rates. The requirement for states to provide continuous eligibility to enrollees expires the last day of the month in which the PHE ends (continuous eligibility period). Some states require legislative action to appropriate federal dollars as well as state dollars; others do not. Medicaid Eligibility is limited to Former Republican Governor Kasich of Ohio adopted the expansion without support from the full Legislature by attaining approval to use federal expansion funds from a seven-member legislative panel. In addition, state legislatures may change Medicaid eligibility, services, and reimbursement during the year. But Georgia's plan called Georgia Pathways to Coverage has proceeded and is beginning in July. The Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act also includes a provision offering states a time-limited 10% enhanced FMAP for activities to increase HCBS during and after the PHE period ends, including increasing the number of individuals receiving HCBS. The other four MOE requirements and the enhanced FMAP funding last through the end of the quarter in which the PHE ends (MOE period). For MAGI populations, states may only renew eligibility once every 12 months unless the state receives information from the beneficiary or through data sources indicating a change in circumstances that may affect eligibility. An Overview of State Approaches to Adopting the Medicaid Expansion, traditional federal medical assistance percentage (FMAP) rates, use ACA enhanced federal matching funds for a partial expansion to 100% FPL, transitioned Pennsylvanias Medicaid expansion, first implementing the expansion under a waiver in 2014, Funding for the state share of Medicaid expansion costs, advantages and disadvantages associated with different approaches, Status of State Medicaid Expansion Decisions: Interactive Map, Section 1115 Medicaid Demonstration Waivers: The Current Landscape of Approved and Pending Waivers, Partial Medicaid Expansion with ACA Enhanced Matching Funds: Implications for Financing and Coverage, Medicaid Waiver Tracker: Approved and Pending Section 1115 Waivers by State, Re-approval of Kentucky Medicaid Demonstration Waiver, An Early Look at Medicaid Expansion Waiver Implementation in Michigan and Indiana. Will CMS issue additional guidance to help states manage backlogs and establish redetermination policies and processes when the MOE requirements expire? certain maintenance of eligibility (MOE) requirements that include ensuring continuous coverage for current enrollees. Published: Jul 03, 2023 The Affordable Care Act's (ACA) Medicaid expansion expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($20,120 for an. Following expansion and HELP-Link implementation, labor force participation among low-income Montanans ages 18-64 increased by four to six percentage points relative to the change among the same population in other states or relative to the change among higher-income Montanans.73 Although Louisiana considered multiple work requirement-related bills in 2018, the state ultimately adopted legislation creating a voluntary workforce training and education pilot program for people receiving public benefits (including Medicaid) that went into effect in August 2018.74 Similar voluntary work support programs are also under consideration in Kansas and Idaho as of February 2019.75,76. The information here is the most current we have on file. Specifically, states must provide continuous eligibility through the end of the month in which the PHE ends for those enrolled as of March 18, 2020, or at any time thereafter during the PHE period. A Biden Administration can increase outreach and enrollment efforts for Medicaid and Marketplace coverage. If an enrollee is determined no longer eligible for Medicaid under any eligibility pathway, states must maintain the same coverage through the end of the month in which the PHE ends. Beyond the MOE requirements, states can streamline eligibility and enrollment processes to help connect people to coverage more quickly, and many are doing so through emergency authorities. Within those parameters, each of the fifty states operates their Medicaid program differently. Many of the states that have adopted the Medicaid expansion have done so initially through the standard legislative process legislation was passed authorizing the Medicaid expansion (either in a stand-alone bill or as part of budget legislation) and expansion was implemented under SPA authority. In Arkansas, the original legislation adopting the expansion mandated that the Arkansas Legislature reauthorize the expansion program annually.68 Arkansas private option approach to Medicaid expansion has undergone multiple modifications since initial implementation in 2014, as a result of decisions during the reauthorization process, requirements in the original expansion legislation, and a gubernatorial transition in 2015 when Republican Governor Hutchinson succeeded former Democratic Governor Beebe.69 In Michigan, the original state legislation authorizing expansion included requirements directing the state to submit waiver and waiver amendment requests at multiple points in time in the years following initial implementation. If CMS later determines that the state does not satisfy all of the conditions, the state must return the enhanced funds.14 CMS has stated it is not aware of any states not taking enhanced federal funds.15. In addition to the alternative names in the table below, several states refer to their Medicaid program as their State Plan or as Title XIX. The Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act passed by the House in May and then updated and passed again in October would increase the enhanced FMAP to 14% effective through September 2021 to support states as the COVID-19 pandemic continues. The MOE requirements are tied to the COVID-19 PHE period, but specific requirements expire at different times (Appendix Table 1). commission. Ohio law requires that money must be formally appropriated before it can be spent, and this is typically done through a vote of the General Assembly, but the Controlling Board also has the authority to adjust appropriations.29 This approach to expansion in Ohio faced a court challenge but was ultimately upheld.30, Some states have enacted laws prohibiting Medicaid expansion without legislative approval. Follow @RRudowitz on Twitter The President-elect has supported the Medicaid expansion under the Affordable Care Act (ACA) and has proposed broader coverage expansions using a federal public option to cover more low-income Americans, including those in states that have not expanded. After submitting an application, it usually takes between 15 and 90 days to receive a letter of approval. The Trump Administration proposed changes to Social Security regulations that would increase the number and frequency of continuing disability reviews for children and adults who receive SSI benefits. Each states circumstances are unique; the actions taken by one state may not apply to another states circumstances. However, the Arizona Supreme Court rejected the challenge in March 2017, ruling that the assessment is legal and that Medicaid expansion could continue.78, In Louisiana, legislators passed a bill that provided a funding mechanism for expansion (allowing hospitals to implement an assessment) several months prior to expansion adoption.79 In response to concern about possible changes to federal expansion funding levels from those currently provided and specified in the ACA, a number of states have included trigger provisions in their expansion legislation that would end the expansion program if federal funding levels change.80. The Fairness Project, a key group that supported successful 2018 expansion ballot initiatives, is considering mounting similar ballot initiative campaigns in Florida, Mississippi, Missouri, Oklahoma, South Dakota, and/or Wyoming.49 These six states are the only non-expansion states as of February 2019 in which citizens can initiate a public vote on the expansion issue.50, Voter-approved ballot measures may face barriers to implementation based on state law requirements, efforts to block or amend the policies by legislators or governors, or legal challenges. 5 Targeted Actions a Biden Administration Could Use to Expand Medicaid Coverage, emergency authorities to expand eligibility for individuals who need long-term services and supports, automatic Medicaid countercyclical financing model, Potential Health Policy Administrative Actions Under President Biden, The Landscape of Medicaid Demonstration Waivers Ahead of the 2020 Election, Medicaid Maintenance of Eligibility (MOE) Requirements: Issues to Watch. Specific actions states are taking include expanding Medicaid coverage to optional groups, allowing increased used of self-attestation to expedite enrollment, eliminating premiums, as well as expanded use of presumptive eligibility. States may also establish or increase cost-sharing and increase the patient liability amount for those receiving long-term services and supports (LTSS) under post-eligibility treatment of income rules. Other states, such as New York11 and New Mexico,12 included the Medicaid expansion as part of budget bills passed in 2013. CMS also has not yet approved Washingtons request to use Medicaid waiver authority create a Disaster Relief Fund to cover costs associated with the treatment of uninsured individuals with COVID-19, housing, nutrition supports and other COVID related expenditures. Increasing the frequency of SSI continuing disability reviews could result in some enrollees losing Medicaid coverage for which they remain eligible, due to difficulty navigating the administrative process. "We've signed a sustainable budget that sets aside reserves to protect for future downturns. This includes a review of the (1) program eligibility requirements, (2) types of meals provided, (3) costs of meal prep and delivery, (4) comparing the number of program participants to the estimated number of people needing nutritional services, (5) looking at funding level adequacy, and (6) process for contracting with elderly nutrition . Outreach under the ACA was also reduced by 90%. If eligibility is terminated due to failure to timely respond to a renewal request, states must provide a 90 day reconsideration window where individuals in MAGI groups can provide the necessary information to re-establish eligibility without completing a new application; the 90-day reconsideration period is optional for non-MAGI groups. For example, Utahs expansion ballot measure included a 0.15% increase from 4.70% to 4.85% of the state sales tax (except for groceries) to finance the expansion or Medicaid and CHIP more broadly.77, Montana and Oregon are examples of states that sought to use ballot initiatives to secure or reject new funding sources for the state share of Medicaid expansion costs, as described in the ballot initiatives section above. Share on Facebook. - Governor John Carney on Friday reflected on legislative actions taken during the 152nd session of the General Assembly: "We've done a lot this legislative session to move the state forward," said Governor Carney. For example, in Arizona, Governor Brewer strongly supported adopting the Medicaid expansion while the state legislature initially was hesitant; after lobbying legislators and building public support, legislators passed the states budget with the Medicaid expansion.13. Expansion approaches adopted through the ballot may also face challenges or delays to implementation from litigation (as occurred in Idaho) or from resistant governors (as occurred in Maine). All states are required to use a SPA to implement ACA Medicaid expansion coverage, however, some states have obtained approval through Section 1115 waivers to implement the expansion in ways that extend beyond the flexibility provided by the law.14 While Section 1115 waivers require additional steps to obtain federal approval, the process may be largely the same at the state level, as if the state were not seeking expansion program changes through a waiver. While state approaches to adopting the Medicaid expansion can generally be grouped into the four categories discussed above, state approaches vary widely within each category, and state approaches are not statica state may change its approach over time in response to elections, new policy options, or other factors. There has been bi-partisan support for legislation that would allow states to extend postpartum Medicaid coverage from the current 60 days to 12 months. Legislative proposals could focus on extending coverage for specific populations including postpartum women, those needing community based long-term care, those ready to transition out of the criminal justice system and recent immigrants. States can alleviate potential backlogs at the end of the PHE by continuing to process ex parte renewals and extend eligibility for an additional 12 months or start new 12-month coverage periods following a change in circumstance. Woman reaches end of 60 day post-partum period. Will there be changes to the amount and duration of the fiscal relief and MOE requirements? While it does not cover how every state has enacted the Medicaid expansion, this issue brief highlights some of the different actions states have taken in response to the Medicaid expansion option. The new Biden Administration will face decisions around continuing to extend the PHE, revising the current MOE rules and about guidance for renewals post PHE. The relationship between the state Medicaid agencies and the Centers for Medicare and Medicaid Services (CMS), the federal agency administering the Medicaid program, is governed by a document called a Medicaid state plan. Funding for the state share of Medicaid expansion costs has been a major concern among lawmakers and others who are (or have been) reluctant to adopt the Medicaid expansion in their state. its Medicaid program or the cost-sharing limits that may be imposed on recipients; or it may have a general requirement that mandates state legislative approval before the state Medicaid agency can amend its state plan or before it can make substantive changes in its Medicaid However, it remains unclear if Congress will provide additional relief through the FMAP or if they will revisit the MOE requirements as part of another coronavirus relief package. Beyond the MOE requirements, nearly all (47) states are making changes to streamline eligibility and/or enrollment to help connect people to coverage more quickly during the pandemic. Arizonas budget legislation that enacted the expansion called for the implementation of a new hospital provider fee to fund state costs of the Medicaid expansion. During the continuous coverage requirements growth in the program was highest among the Expansion coverage group which consists of adults between the ages of 19-64. State legislatures may change Medicaid eligibility requirements during the year, sometimes more than once Which requirements are used to determine Medicaid eligibility for mandatory categorically needy eligibility groups? Congress could also consider alternative options to target the relief to states experiencing higher enrollment increases. Formally, one cannot transfer Medicaid from state to state. This brief provides an overview of these MOE requirements, examines what happens when the MOE expires, and discusses key issues to consider looking ahead. In March 2013, former Governor McCrory of North Carolina signed legislation that prevented any department, agency or institution of the state from expanding eligibility under the ACA Medicaid expansion in North Carolina unless directed to do so by the General Assembly.31 Similar stand-alone legislation was also passed in states such as Georgia,32 Tennessee,33 and Kansas.34 Legislatures in other states, such as Virginia, have included language requiring legislative approval before implementing the Medicaid expansion in state budgets.35, Most recently, Republican legislators in Wisconsin passed and outgoing Republican Governor Walker signed legislation during a lame-duck session in December 2018 restricting the executive branchs authority to make changes to the Medicaid program (this occurred just before the start of new Democratic Governor Evers administration in January 2019). The MOE requirements also provide continuous coverage for current enrollees. New expansion coverage became effective in Virginia under a SPA in January 2019, and the state is currently negotiating the terms of a waiver request (with provisions applying to both expansion and traditional Medicaid populations) that they submitted in November 2018.21 This two-step approach enables the state to make coverage available more quickly while taking additional time needed to develop, negotiate, and implement more complex policies through a waiver. If Congressional support for more sweeping health care proposals is lacking including a public option that would cover poor adults in states that have not expanded Medicaid the Biden Administration may consider more targeted legislative changes to Medicaid to encourage Medicaid expansion, such as legislation to allow 100% federal matching funds for states that newly adopt the expansion for a period of time. While such measures were encouraged to reduce instances of ineligible people being enrolled in the program and other eligibility errors, they also have resulted in creating greater enrollment barriers for people who remain eligible for the program. For example, the Biden Administration could approve pending waivers and encourage additional waivers to extend the postpartum coverage period beyond 60 days, or encourage waiver proposals to extend coverage to incarcerated individuals prior to release, and to allow 12-month continuous eligibility for adults. For example, expansion-authorizing legislation in Montana also authorized the state to administer a voluntary workforce development program (known as the HELP-Link program). Expansion was also initially adopted without approval from the legislature in Pennsylvania. A Biden Administration can reverse current policies that impose enrollment barriers making it more difficult for those who are eligible for Medicaid to maintain coverage. The PACE Participants eligibility group gives states, which have elected to provide PACE coverage, the option to extend Medicaid eligibility to PACE program enrollees who generally would not otherwise be eligible for .