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.

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 

Guidance for Medicaid and CHIP Eligibility Workers

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.

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.

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).

Additional resources developed through this Collaborative are available to state officials through the Collaborative Application Lifecycle Tool (CALT).