Alternative Benefit Plan Eligibility

Eligibility Group for Alternative Benefit Plans

States can generally choose which Eligibility groups of people they will enroll in an Alternative Benefit Plan (ABP). 

New Adult VIII Group

The Affordable Care Act of 2010 expands Medicaid to individuals ages 19 through 64 at or below 133% FPL. States that elect to expand Medicaid to the new adult group are required to provide benefits through ABPs.  

Medically Frail Populations

The Final Rule modifies the definition of “medically frail” and includes the addition of people with chronic substance use disorders.

Individuals in the new adult group, if determined to be medically frail, will receive the choice of an ABP defined using Essential Health Benefits (EHBs) or an ABP defined as the state’s approved Medicaid state plan. Medically frail individuals in eligibility groups other than the ABP must be voluntarily enrolled.