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

MaryBeth Musumeci, Priya Chidambaram, and Molly O’Malley Watts
Published: Jun 26, 2019

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?
State	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?
State	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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