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Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies as of January 2016: Findings from a 50-State Survey

Medicaid and CHIP Eligibility
  1. Iowa also used state funds to cover immigrant children in foster care.

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  2. This group of adults may include some adults with disabilities who are not eligible for Medicare.

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  3. MaryBeth Musumeci and Robin Rudowitz, The ACA and Medicaid Expansion Waivers (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, November 2015), https://www.kff.org/medicaid/issue-brief/the-aca-and-medicaid-expansion-waivers/.

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  4. Stan Dorn and Jennifer Tolbert, The ACA’s Basic Health Program Option: Federal Requirements and State Trade-Offs (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, November 2014), https://www.kff.org/health-reform/report/the-acas-basic-health-program-option-federal-requirements-and-state-trade-offs/.

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  5. Rachel Garfield and Anthony Damico, The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update  (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, October 2015), https://www.kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/.

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Medicaid and CHIP Enrollment and Renewal Processes
  1. 80 Fed. Reg. 75817-75843 (December 4, 2015). Available at https://www.federalregister.gov/articles/2015/12/04/2015-30591/medicaid-program-mechanized-claims-processing-and-information-retrieval-systems-9010.

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  2. Kevin Concannon, Kevin Counihan, Mark Greenberg and Victoria Wachino, Tri-Agency Letter on Additional Guidance to States on the OMB Circular A-87 Cost Allocation Exception, July 20, 2015. Available at http://www.medicaid.gov/federal-policy-guidance/downloads/SMD072015.pdf.

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  3. Vikki Wachino, CMS Letter to State Medicaid Directors and State Health Officials, SHO # 15-001; ACA #34 Re: Policy Options for Using SNAP to Determine Medicaid Eligibility and an Update on Targeted Enrollment Strategies, August 31, 2015. Available at https://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-15-001.pdf.

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  4. Jocelyn Guyer, Tanya Schwartz, and Samantha Artiga, Fast Track to Coverage: Facilitating Enrollment of Eligible People into the Medicaid Expansion (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, November 2013), https://www.kff.org/medicaid/issue-brief/fast-track-to-coverage-facilitating-enrollment-of-eligible-people-into-the-medicaid-expansion/.

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  5. “Targeted Enrollment Strategies,” CMS, accessed December 2015, http://www.medicaid.gov/medicaid-chip-program-information/program-information/targeted-enrollment-strategies/targeted-enrollment-strategies.html.

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Premiums and Cost-Sharing
  1. The Medicaid and CHIP Payment and Access Commission (MACPAC) has indicated that the prevalent use of premiums in CHIP leads to the problem of ‘premium stacking’ for families, in which families have to pay both premiums for children enrolled in CHIP and for adults enrolled in Marketplace coverage. MACPAC notes that these combined premiums could constitute a percentage of a family’s income that is higher than the limits established by the ACA. For more information see Medicaid and CHIP Payment and Access Commission, “Chapter 5: Children’s Coverage under CHIP and Exchange Plans,” in Report to the Congress on Medicaid and CHIP (Washington, DC: March 2014), 150-182, https://www.macpac.gov/wp-content/uploads/2015/01/2014-03-14_Macpac_Report.pdf.

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  2. On December 17, 2015, Michigan received approval for a waiver amendment. Under the approved waiver amendment, beneficiaries between 100% and 138% FPL who are not medically frail could choose between two coverage options as of April 2018: continued coverage through Medicaid managed care or the Healthy Michigan Plan or Marketplace coverage through a Qualified Health Plan (QHP) or the Marketplace Option. If beneficiaries choose Medicaid managed care, they will be required to meet a healthy behavior requirement or they could be transitioned to a QHP plan. Beneficiaries above 100% FPL would face monthly premiums of up to 2% of income in both Healthy Michigan and QHPs, but failure to pay would not result in termination of eligibility. See, Kaiser Commission on Medicaid and the Uninsured, Medicaid Expansion in Michigan (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, January 2016), https://www.kff.org/medicaid/fact-sheet/medicaid-expansion-in-michigan/.

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