The Centers for Medicare & Medicaid Services (CMS) recently released a proposed rule describing how states should handle eligibility determinations for Medicaid and other income assistance programs on new state-based health insurance exchanges, beginning in January 2014.
The proposed rule details how state Medicaid programs will coordinate with the exchanges on implementing new eligibility guidelines under the “Patient Protection and Affordable Care Act” for Medicaid and the Children’s Health Insurance Program (CHIP).
The rule modifies existing “benchmark” regulations that apply to Medicaid programs to carry out the benefit options available to lowincome adults, including single adults younger than 65, with income up to 133% of the federal poverty level. Benchmark plans generally reflect the benefits offered in such plans as the Federal Employees Health Insurance Benefits Program (Blue Cross/Blue Shield Preferred Provider Option), state employees’ health coverage, and health insurance plans offered through a health maintenance organization with the largest insured commercial non-Medicaid enrollment in the state.
Among other provisions, the rule proposes a single set of rules for Medicaid premiums and cost sharing, while allowing states to impose higher cost sharing for nonemergency use of hospital emergency departments and non-preferred drugs.
The proposed rule explains how states will align citizenship and income determinations across Medicaid, CHIP, and the insurance exchanges, using a new federal data services hub. The electronic hub will provide states with access to records from the Social Security Administration, Internal Revenue Service, and Department of Homeland Security. Cindy Mann, director of CMS’ Center for Medicaid and CHIP Services, told reporters in a Jan. 14 conference call that the new rule will take effect in 2014, “regardless of whether the states are participating in the Medicaid expansion.” The U.S. Supreme Court made the expansion optional for states in its landmark health care decision last June.