New Medicaid, CHIP Eligibility Formula Puts Coverage at Risk
Many Medicaid and Children's Health Insurance Program beneficiaries who enrolled in coverage before the Affordable Care Act implemented a new eligibility formula risk losing their insurance because they are unaware of the new requirements or unable to supply the necessary data, according to advocates, Modern Healthcare reports.
Under the Affordable Care Act, states beginning Jan. 1, 2014, are required to assess eligibility for Medicaid and CHIP beneficiaries using the Modified Adjusted Gross Income standard formula to define household income. According to Modern Healthcare, states previously used a variety of methodologies to determine CHIP and Medicaid eligibility.
Concerns About MAGI Assessment Requirements
Medicaid and CHIP beneficiaries who enrolled prior to the MAGI implementation date could lose their coverage because they might not understand why their states are requesting additional information, according to advocates. Further, some advocates said the renewal forms are too complex and often pose language barriers, causing beneficiaries not to submit redetermination forms.
For example, advocates in California have filed a lawsuit against the California Department of Health Care Services, alleging that the state is wrongfully dropping beneficiaries from Medi-Cal, the state's Medicaid program. The lawsuit alleges that renewal forms did not adequately explain what information was needed under the new MAGI standard. According to Modern Healthcare, roughly one million California residents could lose their Medicaid or CHIP coverage.
Similarly, 77,000 pre-ACA beneficiaries in Oregon were dropped from coverage because they did not submit renewal forms in time.
By contrast, advocates have said that the roughly nine million people who enrolled in CHIP or Medicaid coverage since October 2013 likely will not have difficultly being re-enrolled because their initial eligibility was assessed under the MAGI standard.
Further, officials in Colorado and Kentucky say they have not experienced major issues re-enrolling beneficiaries under the MAGI standard, in part because of updated and integrated information technology systems (Dickson, Modern Healthcare, 11/25).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.