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State Medicaid & CHIP Policies for 2014

Every state’s Medicaid and CHIP program is changing and improving – many are expanding coverage for low-income adults; all states are modernizing their Medicaid/CHIP enrollment and renewal processes and improving their applications. Finally, states are coordinating the application and enrollment process with the messaging and policies for the Health Insurance Marketplace operating in their state to ensure that there is no wrong door to coverage. Below are links to some key documents and information about the Affordable Care Act’s Medicaid/CHIP changes to states' programs.

To view the Medicaid Moving Forward in 2014 national tables click here.

New York
New Hampshire
New Jersey
New Mexico
North Carolina
North Dakota
Rhode Island
South Carolina
South Dakota
West Virginia
District of Columbia
New Jersey
Rhode Island
New Hampshire

Application and Enrollment in 2014

The Affordable Care Act establishes a streamlined enrollment process through which individuals can gain access to affordable insurance coverage for which they are eligible. The law directs the Secretary of HHS to develop a model application that will be used to apply for coverage through the Marketplace, Medicaid and the Children’s Health Insurance Program (CHIP). States have the option to adopt the Secretary of HHS’s model application form for affordable insurance programs or to adopt an alternative application that meets federal requirements. There is variation across states in the degree to which the alternative applications resemble the Secretary’s model and some states are continuing to modify their applications, but every state is offering a single application for the Marketplace, Medicaid and CHIP that will enable consumers to enroll in the coverage program that is appropriate for them. Not all states have their on-line applications ready for use on October 1st (for more information see each state’s “Consumer Experience Profile”).  To view information about how to apply for Medicaid/CHIP coverage in a state, select a state from the map above.

Consumer Experience Profiles

The Consumer Experience Day 1 Profiles summarize each state’s application and enrollment process to date.. The Profiles are designed to offer a high level overview for consumer assistance organizations and others who may be providing information to individuals about how to enroll in health coverage. The documents describe what form of application the state will have in place for enrollment in Medicaid, CHIP and the Marketplace and the venues through which individuals can apply. The profiles describe how the coordination between Medicaid, CHIP and the Marketplace will work and gives those who are assisting consumers a sense of what to expect in terms of application processing times and the role the Marketplace will play in assessing or determining Medicaid/CHIP eligibility in that state. The profiles will be updated as states’ systems capabilities evolve over the coming months. select a state from the map above to view the Consumer Experience Profiles.

Medicaid/CHIP Eligibility Verification Plans

New, modernized rules regarding verification of Medicaid and Children's Health Insurance Program (CHIP) eligibility will mean that state Medicaid and CHIP agencies will rely primarily on information available through data sources (e.g., the Social Security Administration, the Departments of Homeland Security and Labor) rather than paper documentation from families.  Each state has prepared a verification plan for Medicaid and CHIP in order to comply with the new rules. To view each state's plan, select a state from the map above.

MAGI Conversion Plans

CMS provided states with a template for completing their “MAGI Conversion Plans” that are designed to reflect the MAGI-based eligibility standards that will be in place in 2014. The MAGI-conversion process involved a translation of pre-2014 net income eligibility standards into MAGI-based eligibility standards. Moving to MAGI replaces income disregards with simpler, more universal income eligibility rules that are generally aligned with the rules that will be used to determine eligibility for the premium tax credits that will be available in the Marketplace. To complete the transformation to MAGI, states needed to “convert” their net-income based eligibility standards to MAGI-based standards. In addition, the new rules discontinue use of assets tests in determining Medicaid eligibility. 

In December 2012, CMS provided three options to choose from in selecting a MAGI conversion methodology – for 1) CMS to perform the conversions on behalf of states using a standardized methodology based on the Survey of Income and Program Participation (SIPP), adjusted for each state’s demographic situation; 2) states to perform the conversion using the standardized methodology using state-generated data; or 3) states to propose an alternative conversion methodology based on state data. The converted standards set the minimum and the maximum eligibility levels for the specified group; states then identify their new income standards on their Medicaid and CHIP state plan amendments (SPAs), based on the converted levels provided in the approved MAGI conversion plans. Select a state from the map above to view states’ approved MAGI conversion plans.

Medicaid/CHIP State Plan Amendments

The state Medicaid and CHIP plan spells out how each state has chosen to design its program within the broad requirements for federal funding. As always, states need to amend their Medicaid and CHIP state plans in order to secure legal authority and also federal financing for each of the approaches they adopt for enrolling and serving their beneficiaries. The 50-state map provides a link to each state’s 2014 related eligibility and alternative benefit plan SPAs that are needed to conform to the provisions of the Affordable Care Act. To view approved Medicaid and CHIP state plan amendments, select a state from the map above.  States are continuing to submit and CMS is continuing to review state plan amendments implementing the Affordable Care Act.