Expanding Coverage Under the Affordable Care Act
The Expanding Coverage MAC Learning Collaborative is providing a forum for states and the Centers for Medicare & Medicaid Services (CMS) to translate the Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment standards and processes required by the Affordable Care Act into program design options. Products developed or used by the Collaborative include:
Cost Sharing and Premium Rules for Medicaid
Covers maximum limits for medical services and prescription drugs; cost sharing by population; penalties for failure to pay cost sharing; and State Plan Amendment requirements. Provides an overview of federal premium requirements, maximum aggregate cost sharing and premium limits, and states’ experiences with monitoring consumer cost sharing and premium payments.
- Cost sharing and premium rules for Medicaid, November 2014
Eligibility and Verification
Information and tools to assist states in implementing relevant eligibility requirements and eligibility-related notice requirements. The model notices are not intended to provide policy guidance on state Medicaid/CHIP program design.
Model Eligibility Notices Toolkit
- State toolkit guide, September 2014
- Tool 1 – Statutory and regulatory review, September 2014
- Tool 2 – Key messages menu set, September 2014
- Tool 3 – Notices content template, September 2014
- Tool 4 – Model notices, September 2014
Guidance for Medicaid and CHIP Eligibility Workers
- Affordable Care Act Overview: A Primer, November 2013
- Household composition and income eligibility detailed rules, November 2013
- Federal Requirements and State Flexibilities for Verifying Eligibility Criteria, May 2012
Hospital Presumptive Eligibility
To assist states in implementing hospital presumptive eligibility – whereby hospitals can immediately enroll patients who are likely eligible under a state’s Medicaid eligibility guidelines for a temporary period of time.
- Hospital Presumptive Eligibility Model Application and Memorandum of Understanding, February 2014
- Model application form, February 2014
- Federal single streamlined application with required items marked for presumptive eligibility, February 2014
- Model memorandum of understanding, February 2014
- Resources for Implementing the HPE Program, December 2013
- Frequently asked questions, January 2014
- Training template for qualified hospitals, December 2013
- Form templates for hospitals, December 2013
- Implementation of the Affordable Care Act’s Hospital Presumptive Eligibility Option: Considerations for State, November 2013
Medicaid and CHIP Renewals and Coverage Transitions
Information to assist states in meeting regulatory requirements for renewing eligibility, facilitating a streamlined renewal process using the Modified Adjusted Gross Income (MAGI) methodology, and effectuating seamless coverage transitions as people move between Medicaid, CHIP, and the Marketplace.
- Medicaid/CHIP Renewal: State Practices, Lessons Learned & Opportunities. August 13, 2015
- Streamlining Medicaid and CHIP Renewals, July 2014
- Coverage Transitions in 1115 Demonstration States, July 2013
- Example Medicaid renewal form, July 2013
- Model Renewal Form and Considerations in 2013-2014, July 2013
Single Streamlined Application Guidance
Resources and tools to assist states implementing the requirement that each state develop a single, streamlined application that serves as a single point of entry for individual to be determined eligible for Medicaid, CHIP, and Advanced Payments of the Premium Tax Credits(APTC)/Cost Sharing Reductions (CSR).
- Integrated human services application analysis, June 2013
- High-level summary chart, June 2013
- Cross-walk of model application, June 2013
Additional resources developed through this Collaborative are available to state officials through the Collaborative Application Lifecycle Tool (CALT).