Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

National Survey Finds Strengths of Medicaid and CHIP Program

By Ryan Mcaskill

The 13th annual 50 state survey examined Medicaid and CHIP eligibility, enrollment, renewal and cost-sharing system.

- One of the biggest impacts of the Affordable Care Act (ACA) has been the expansion of systems like Medicaid and the Children’s Health Insurance Program (CHIP). This is all part of the ultimate goal of expanding coverage and streamlining enrollment systems. However, each of these platforms are heavily influenced by individual states.

The Kaiser Family Foundation released its 13th annual 50-state survey of Medicaid and CHIP eligibility, enrollment renewal and cost-sharing policies as of the start of the year. The report surveys program officials to track eligibility, enrollment , renewal and premium and cost sharing policies and to gather information on key policies that are in effect as of January 1, 2015.

Eligibility

At the start of the year, 28 states have their Medicaid income eligibility levels set to at least 138 percent of the federal poverty level (FPL), which highlights implementation of the ACA Medicaid expansion. Among these states, the median Medicaid income eligibility level for adults was 106 percent of the FPL in january 2013, prior to the implementation of the ACA.

In the 23 states that have not adopted Medicaid expansion, 19 of them were under the 67 percent of the FPL. Three of the remaining four hover within a few percentage points of 100 percent and Arkansas tops the list at 146 percent.

There were strong numbers when it comes to coverage for children and pregnant women. All but two states cover children at or above 200 percent of the FPL, with 19 states going as high as 300 percent.

Streamlined Enrollment or Renewal

One of the most significant areas of progress that was identified includes modernization and a more streamlined enrollment and renewal process. This can be seen in the fact that individuals can apply online for Medicaid at the state level in all but one state. Also a majority of states accept applications by phone.

Many states have also started embracing electronic data and minimizing paperwork to help establish eligibility verification. This all points to improved, streamlined operations.

Premiums and Cost Savings

Overall, premiums and cost-sharing remain limited in Medicaid CHIP. At the time of the study, 30 states charge premiums or enrollment fees for children, primarily in CHIP and 26 states have cost-sharing when it comes to children. There are no charge premiums for parents or ACA expansion adults in traditional Medicaid. Furthermore, most states charge normal cost-sharing for low-income parents and expansion adults.

The Future

All of the data collected from the survey show that a strong future is ahead.

“One year after the launch of the major Medicaid provisions of the ACA, there have been significant gains in coverage opportunities for low-income adults, most notably with increased eligibility levels for parents and childless adults in states that have expanded Medicaid,” the report reads.

However, there is still some strides that can be made. This includes the debate over the adult expansion and federal funding for CHIPs ends in September 2015 without an extension, which could have budgetary implications for states.

 

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