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  • Implications of the Expiration of Medicaid Long-Term Care Spousal Impoverishment Rules for Community Integration

    Issue Brief

    To financially qualify for Medicaid long-term services and supports (LTSS), an individual must have a low income and limited assets. In response to concerns that these rules could leave a spouse without adequate means of support when a married individual needs LTSS, Congress created the spousal impoverishment rules in 1988. Originally, these rules required states to protect a portion of a married couple’s income and assets to provide for the “community spouse’s” living expenses when determining nursing home financial eligibility, but gave states the option to apply the rules to home and community-based services (HCBS) waivers.
    Section 2404 of the Affordable Care Act (ACA) changed the spousal impoverishment rules to treat Medicaid HCBS and institutional care equally from January 2014 through December 2018. Congress subsequently extended Section 2404 through December 2019. This issue brief answers key questions about the spousal impoverishment rules, presents 50-state data from a 2018 Kaiser Family Foundation survey about state policies and future plans in this area, and considers the implications if Congress does not further extend Section 2404.

  • State Actions to Facilitate Access to Medicaid and CHIP Coverage in Response to COVID-19

    Issue Brief

    This brief summarizes state changes to Medicaid and CHIP eligibility and enrollment policies in response to the COVID-19 outbreak, beyond those required to access enhanced federal funding. It is based on KFF analysis of approved Medicaid and CHIP state plan amendments (SPAs) and information on state websites as of May 21, 2020.

  • Key Themes in Medicaid Section 1115 Behavioral Health Waivers

    Issue Brief

    State interest in Medicaid Section 1115 behavioral health waivers, including mental health and substance use disorders, remains high. As of November, 2017, there are 15 approved and 11 pending behavioral health waivers in 22 states. This issue brief describes recent waiver activity in four areas: using Medicaid funds to pay for substance use and/or mental health services in “institutions for mental disease” (IMDs), expanding community-based behavioral health benefits, expanding Medicaid eligibility to cover additional people with behavioral health needs, and financing delivery system reforms.

  • Unwinding of the PHE: Maintaining Medicaid for People with Limited English Proficiency

    Issue Brief

    Provisions in the Families First Coronavirus Response Act (FFCRA) require states to maintain continuous Medicaid enrollment for enrollees until the end of the month when the COVID-19 public health emergency (PHE) ends. When the continuous enrollment requirements end and states resume redeterminations and disenrollments, individuals with LEP may be at increased risk of losing Medicaid coverage or experiencing a gap in coverage due to barriers completing these processes, even if they remain eligible for coverage.

  • Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022: Findings from a 50-State Survey

    Report

    The 20th annual survey of state Medicaid and CHIP program officials conducted by the Kaiser Family Foundation (KFF) and the Georgetown University Center for Children and Families in January 2022 presents a snapshot of actions states are taking to prepare for the lifting of the continuous enrollment requirement, as well as key state Medicaid eligibility, enrollment and renewal procedures in place during the PHE.

  • A 50-State Review of Access to State Medicaid Program Information for People with Limited English Proficiency and/or Disabilities Ahead of the PHE Unwinding

    Issue Brief

    This issue brief reviews accessibility of information for people with LEP and people with disabilities provided through state Medicaid websites and call center automated phone trees as of June 16, 2022. The analysis shows that while states have taken some steps to support access to information and applications for people with LEP and people with disabilities, gaps in accessibility remain.

  • Understanding Medicaid Ex Parte Renewals During the Unwinding

    Policy Watch

    As states unwind the Medicaid continuous enrollment provision, they must comply with federal renewal requirements, including the requirement to conduct ex parte, or automated renewals. This policy watch explains what ex parte renewals are, examines variation in ex parte renewal rates across states, and discusses current issues as well as actions states are taking to increase ex parte rates.