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Key State Policy Choices About Medical Frailty Determinations for Medicaid Expansion Adults

Appendix Table 1: State Policy Choices About Medical Frailty Determinations for ACA Expansion Adults, 2018
State Who can identify someone as Medically Frail? Who makes the final Medically Frail Determination?
Self State Health Plan Provider Enrollment Broker State Health Plan Provider Enrollment Broker
TOTAL 8 3 6 6 1 9 4 2 2
Arkansas
California
Indiana*
Iowa
Massachusetts
Michigan
Montana
Nevada
New Hampshire
New Jersey
North Dakota
West Virginia
NOTES: NR = No response. *Indiana’s Section 1115 waiver also requires it to determine medical frailty for traditional low-income parents in addition to ACA expansion adults.
SOURCE: Kaiser Family Foundation, Medicaid Financial Eligibility Survey for Seniors and People with Disabilities, 2018.
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Appendix Table 1 (continued): State Policy Choices About Medical Frailty Determinations for ACA Expansion Adults, 2018
State When is Medical Frailty Determined? How is Medically Frail Status Verified?
Application Renewal During Eligibility Period Claims data Data Match Self-Attestation Provider Certification Medical Records
TOTAL 11 11 11 2 1 7 4 3
Arkansas NR NR NR NR NR
California
Indiana*
Iowa
Massachusetts
Michigan
Montana
Nevada NR
New Hampshire
New Jersey
North Dakota
West Virginia
NOTES: NR = No response. *Indiana’s Section 1115 waiver also requires it to determine medical frailty for traditional low-income parents in addition to ACA expansion adults.
SOURCE: Kaiser Family Foundation, Medicaid Financial Eligibility Survey for Seniors and People with Disabilities, 2018.
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