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Medicaid Expansion Rule Aims for Vastly Simpler Enrollment Process - CQ HealthBeat
Medicaid Expansion
Rule Aims for Vastly Simpler Enrollment Process
By John Reichard, CQ HealthBeat Editor
A final rule released Friday spells out the terms for the expanded Medicaid
eligibility in 2014 under the health care law and requires “real-time”
enrollment that documents income, citizenship and other data without the
applicant having to bring in paperwork.
The rule also collapses the many eligibility categories now in Medicaid
into just four: adults, children, parents and pregnant women.
“I’ll guarantee you that Medicaid will look and feel like a very different
program in 2014,” federal Medicaid director Cindy Mann told reporters on a
telephone briefing.
The rule will make it much easier for states to run their Medicaid
programs, she said. “We had overwhelmingly strong support from all stakeholders
for the rule,” she said. It also will make a big difference for the many
low-income Americans who now go without coverage, she added. “Think for a
minute about a 55-year-old woman who works in a restaurant. Her kids have grown
— left the home — she earns let’s say $12,000 a year. In most states, if she’s
not getting affordable coverage through her workplace, she’s not going to be
eligible for Medicaid even though she really has no options. The Affordable
Care Act fills that gap by expanding eligibility to low-income adults for the
first time in the program.”
The health care law extends Medicaid coverage to all individuals between
ages 19 and 64 with incomes up to 133 percent of the federal poverty level.
That’s $14,856 for an individual and $30,656 for a family based on the 2012
federal poverty level. (While the law specifies 133 percent, in practice it’s
138 percent since states disregard five percent of income in determining
eligibility, Mann noted.)
Mann said that under the health law the application process will be
completed “literally in real time.” As an example, she said an application
filed online at nine in the morning would be processed and, if in order,
approved an hour later.
Health and Human Services is simplifying this process for the states by
serving as a single point of computer entry to federal data sources such as the
Internal Revenue Service to determine income, the Social Security Administration
to determine identity and the Department of Homeland Security to confirm legal
status.
Under the health care law, the uninsured will obtain coverage through
Medicaid or on insurance exchanges using tax credits to help them pay premiums.
In many instances, people won’t know whether they should be applying for
Medicaid or premium tax credits — or in the case of their children, for
Medicaid or the Children’s Health Insurance Program.
No matter, Mann said. Applicants will have to fill out just one
application. They won’t have to know ahead of time whether they should apply to
Medicaid, CHIP or insurances exchanges to get tax credits.
In response to comments on the proposed version of the rule, the final
version provides two ways for exchanges to perform Medicaid-eligibility
evaluations. They can determine themselves whether an applicant qualifies for
Medicaid or make an initial determination of that and rely on state Medicaid
and CHIP agencies for a final determination. If they choose the latter, applications
have to be processed in “timely” fashion, Mann said.
When Medicaid expands, large numbers of uninsured people who qualify for
the program based on current criteria but haven’t enrolled are expected to sign
up for coverage. That is because of expanded outreach efforts and the
requirement in the health law that individuals without coverage pay penalties.
But those qualifying for coverage based on current criteria, the states
will get current federal matching rates, not the enhanced federal matching rate
provided for those newly eligible for Medicaid under the health law. In 2014,
2015 and 2016, the federal government will pay 100 percent of the Medicaid
costs of the newly eligible under the health law; then the federal percentage
gradually drops so that in 2020 it’s 90 percent, where it stays.
Matt Salo, executive director of the National Association of Medicaid
Directors, said in an email that “the provision about how to conveniently
calculate the regular and enhanced match rates for enrollees are not included
in this regulation. CMS anticipates a final rule on these provisions around
October 2012. We understand why it takes so long, because this is
extraordinarily complicated. But the longer any piece takes, the more it
stretches already tight time frames” for the health law. That’s especially the
case “since many state agencies are or soon will be preparing budgets for the
next fiscal year.”
Salo added that state Medicaid agencies will need flexibility on the
deadlines for determining final Medicaid eligibility when they do it rather
than the exchanges.
Separately, CMS released regulations Friday establishing a time frame by
which participants in the Early Retiree Reinsurance Program must use reimbursement funds; and
standards relating to reinsurance, risk corridors and risk adjustment to
eliminate incentives for insurers to avoid covering people in poor health.
Tuesday, March 20, 2012
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House Republicans Introduce Legislation Overhauling Medicaid
House Republicans Introduce Legislation Overhauling Medicaid
BY: Dylan Scott
| Nation | March 7, 2012 governing magazine
States would receive total authority to determine Medicaid
eligibility, benefits and provider reimbursement rates under legislation to be
introduced Wednesday by U.S. Rep. Todd Rokita (R-Ind.).
The official legislation has not yet been filed with the House
clerk, but Rokita's office released a fact sheet outlining the issue and the proposal. Federal funding
for Medicaid and the Children's Health Insurance Program (CHIP) would be
consolidated into a single block grant and capped at current levels for the
next 10 years, reducing spending by $1.8 trillion over that time, according to
Rokita's office.
States would have sole authority to set eligibility standards,
benefit packages and provider reimbursement rates for the insurance program.
Under the proposal, annual independent audits would be conducted to monitor
states' use of federal funding. Forfeiture of federal aid and a 10 percent
penalty would be incurred for misuse of funding, according to Rokita's office.
The bill will be co-sponsored by Rep. Paul Broun (R-Ga.), Rep.
Tim Huelskamp (R-Kansas) and Rep. Jim Jordan (R-Ohio), an aide to Rokita told Governing.
It is based on principles set out by 29 Republican governors last year,
according to Rokita's office.
The viability of the legislation outside the House would be
questionable. By handing full authority to establish eligibility and benefits
to the states, it would seem to conflict with the Affordable Care Act, which
requires states to cover residents with income up to 133 percent of the federal
poverty level in 2014 and onward. Last year, Rep. Paul Ryan (R-Wis.) included a Medicaid block grant in his budget, which passed
the House but was turned down by the Senate
Thursday, March 8, 2012
Wednesday, March 7, 2012
Grassley Wants States to Tell Him How They Oversee Medicaid Managed-Care Plans
Grassley Wants
States to Tell Him How They Oversee Medicaid Managed-Care Plans
By Jane Norman, CQ HealthBeat Associate
Editor
Sen. Charles E. Grassley has
launched a letter-writing campaign to the states to determine whether they are
exercising enough scrutiny over their Medicaid managed-care programs.
Grassley, the ranking Republican on the Judiciary Committee, said Thursday
in identical letters to every state Medicaid director that a 2010 Government
Accountability Office (GAO) report found that the Centers for Medicare and
Medicaid Services (CMS) has been inconsistent in reviewing Medicaid
managed-care plan rates. CMS is required to determine whether states are being
adequately reimbursed for their expenses for the plans; states are supposed to
ensure that as well.
“In the 18 months since that report was issued, I have seen nothing to
convince me CMS or the states have improved in their ability” to verify that
managed-care entities are appropriately and correctly reimbursed for the
services provided, he said.
If a plan is paid too little, the quality of care for beneficiaries is
harmed, and if it is paid too much, it’s diverting scarce Medicaid dollars away
from needed services, he said.
Grassley aides said the state of Minnesota Minnesota
Grassley said in his letter that for years states have been allowed to
provide Medicaid services through private plans so they can better manage
costs, and these entities have proved better at care coordination than public
programs.
However, he said, states also have to be correctly reimbursed, and the risk
of inaccurate reimbursements will grow as the Medicaid program expands under
the health care law.
Grassley asked that each state tell him, by March 16, whether they have
independent audit requirements for managed-care plans and how those audits are
performed. He also asked states for examples of the language in the plan
contracts dealing with allowable medical costs and for examples of documents
that plans give to states reporting on their medical costs, administrative
costs and profits.
Tuesday, March 6, 2012
Former Governors Recommend Reforms to Medicaid Waivers
Former Governors Recommend Reforms to Medicaid Waivers
BY: Dylan Scott
| Nation | March 1, 2012 governing magazine
Can the federal government make it easier for states to adapt
their Medicaid programs to ever-changing circumstances? That is the core
question addressed by the Bipartisan
Policy Center
Their answer: Yes. By streamlining and standardizing the waiver
process, the Centers for Medicare and Medicaid Services (CMS) would allow
states to pursue more innovative strategies that improve care and lower costs,
argued six former governors (three Democrats, three Republicans) who make up
the Governors' Council. Council members include former Govs. Phil Bredesen
(Tennessee), Jim Douglas (Vermont), Brad Henry (Oklahoma), Linda Lingle
(Hawaii), Mike Rounds (South Dakota) and Ted Strickland (Ohio).
For now, the application and review process is “an 800-pound
gorilla,” said Douglas at a briefing with
reporters.
States can apply for three kinds of waivers that exempt them
from certain provisions of the Social Security Act, which allow them to: enroll
Medicaid patients in managed-care programs (Section 1915b); move long-term care
patients into community settings (Section 1915c); and pursue broad reform
initiatives (Section 1115). They can also file for state plan amendments (SPA)
that make minor changes to their Medicaid programs.
The Governors’ Council made six recommendations that they say
would bring more transparency to the waiver process and reduce the
administrative burden for states. Generally, they called for setting clear
parameters and developing templates that would ensure states know what to
include in their applications in order to gain approval. They urged a more
timely process; reviews are supposed to take 90 days, but CMS often extends the
period with further questions. One Tennessee
The governors also recommended establishing a mechanism that
would allow waivers that have proven successful to become permanent or semi-permanent.
For example, Bredesen said his state’s TennCare is built on various waivers.
But every five years, Tennessee Vermont saved more than $260 million
over five years with its Global Committment to Health initiative, Douglas said, but still faced uncertainty when reapplying
for a waiver.
With the Medicaid expansion under the Affordable Care Act (ACA)
looming, the council stressed the necessity of adapting such changes. “These
are going to be triply important,” Bredesen said. “This antiquated, serial
process… needs to be streamlined.” The governors also contend that a more
normalized process would simplify efforts to transfer successful waiver
programs across state lines.
Jason Grumet, president of the Bipartisan Policy
Center
“We should all value efficiency,” Strickland said. “I think
there is a feeling that the process is not as efficient as it could or should
be.”