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Oregon Medicaid Moving Forward in 2014


Oregon is operating a State-Based Marketplace, known as Cover Oregon. The state is expanding Medicaid coverage to low-income adults effective January 1, 2014.

Medicaid and CHIP Eligibility Levels for 2014

To view the new modified adjusted gross income (MAGI)-based eligibility levels, expressed as a percentage of the federal poverty level (FPL) and by monthly dollar amount and family size for Medicaid and the Children's Health Insurance Program (CHIP) beginning on January 1, 2014, visit the National Medicaid and CHIP Eligibility Levels page.

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 Health and Human Services (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.

Medicaid/CHIP Eligibility Verification Plans

New, modernized rules regarding verification of Medicaid and 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.

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.

Medicaid/CHIP State Plan Amendments

The state Medicaid and CHIP plans spell 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.