Below are several options states may consider in implementing section 2101(f). Under each, the state may not find such children ineligible for a separate CHIP based on current or recent insurance coverage or other state-specific restrictions on eligibility. The only restrictions on CHIP eligibility that may be applied to the protected children are those described above in response to Question 5: "Do these children automatically meet the definition of a "targeted low-income child" regardless of other CHIP eligibility factors?"
Option #1: Demonstrate that all Medicaid children qualifying for section 2101(f) protection will qualify for the state's existing separate CHIP.
States with an existing separate CHIP may be able to demonstrate that the income standard for the state's separate CHIP (after conversion for MAGI) is sufficiently above the state's converted Medicaid standard for children that all, or virtually all, children losing Medicaid as a result of the loss of disregards under MAGI will be income-eligible for the state's separate CHIP. The state would need to demonstrate that most if not all affected children would be eligible for the state's separate CHIP without any modification of the program. Note that because state Medicaid programs may cover children in different age ranges (under 1, ages 1- 5, and ages 6-18) up to different income standards, this analysis would need to be done separately for each age range.
Under this option, States would also need to develop procedures to ensure that children being transferred from Medicaid to CHIP after a loss of Medicaid eligibility at their 2014 redetermination are not denied CHIP based on eligibility criteria which may not be applied to these children in accordance with section 2101(f) (see Question 5).
Option #2: Enroll all children in a separate CHIP who lose Medicaid due to income at their first renewal applying MAGI methods.
States can elect to enroll all children into CHIP who lose Medicaid eligibility because of excess income after applying MAGI-based income methodologies and the converted MAGIbased income standard under Medicaid. This option will capture more children than strictly defined under this provision (i.e. children losing Medicaid because of families' increased earned income will also be included) but may be the easiest option to implement administratively.
Option #3: Determine an income standard above the converted MAGI Medicaid FPL that will capture all or almost all the children who would have benefited from application of the former disregards.
Option #4: Identify protected children using 2013 data.
If, upon renewal, the state finds a child ineligible for Medicaid but that child's family income has not increased since the child's last determination of Medicaid eligibility in 2013 (i.e., prior to the application of MAGI-based methods in 2014), the state would automatically enroll the child in its separate CHIP. If the family income has increased since the last Medicaid determination in 2013, the state would identify children protected by section 2101(f) by subtracting the value of the allowed disregards the child received during the 2013 determination from the child's household income based on MAGI in 2014. If the adjusted household income (i.e., 2014 MAGI-based household income minus the value of former disregards in 2013) is at or below the income standard in effect in 2013 for the Medicaid eligibility group under which the child was enrolled, the state would enroll the child in the separate CHIP.
CMS will work with states to ensure the selected option is implemented correctly as we recognize that there must be significant collaboration between Medicaid and CHIP agencies to implement 2101 (f). We are also open to considering alternative proposals from states for how to implement this provision. States are strongly encouraged to talk with CMS in advance of submitting their state plan amendments to implement this provision.
Supplemental Links:
Date: April 25, 2013
Topics:
Affordable Care Act
Subtopics:
Children's Coverage
