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:
Disaster Preparedness Toolkits
Medicaid and CHIP have played a critical role in supporting states and Territories as they respond to major public health crises and natural disasters such as hurricanes, flooding, and wildfires. To help state Medicaid and CHIP agencies prepare for such crises, the Coverage Learning Collaborative developed a set of complementary tools that describe strategies available to support state operations and enrollees in times of crisis. These tools include a slide deck and toolkit that provides a high-level summary of the types of Medicaid and CHIP strategies states and Territories can deploy and a companion inventory documenting the legal authorities and the action needed to effectuate these strategies. States may also access Leading Through Emergencies: a Toolkit for Medicaid which was developed by the National Association of Medicaid Directors and provides high-level checklists to support Medicaid Directors in their decision making before, during and post-emergency.
- Role of Medicaid and CHIP in Responding to Public Health Crises and Disasters (PDF, 1.12 MB) August 13, 2018
- Disaster Preparedness Toolkit for State Medicaid and CHIP Agencies (PDF, 369.77 KB) August 2018
- Inventory of Medicaid and Chip Flexibilities and Authorities in the Event of a Disaster (PDF, 1.66 MB) August 2018
Cost Sharing, Premiums, & Premium Assistance
These resources summarize federal premium and cost sharing requirements for Medicaid, illustrate states’ experiences with monitoring consumer cost sharing and premium payments, and present policy and operational considerations for states pursuing Medicaid premium assistance in the employer-sponsored insurance market.
- ESI Premium Assistance FAQ (PDF, 611.67 KB) July 2015
- Medicaid premium assistance for employer-sponsored insurance (PDF, 3.96 MB) January 2015
- Cost sharing and premium rules for Medicaid (PDF, 4.27 MB) November 2014
- Medicaid QHP Premium Assistance (PDF, 1.1 MB) September 2014
- Children's QHP Premium Assistance (PDF, 927.43 KB) September 2014
Effective Communication of Eligibility Determinations
Information and tools to assist states in implementing eligibility-related notice requirements. The model notices are not intended to provide policy guidance on state Medicaid/CHIP program design.
2017 Model Notices
- Key Messages Menu Set (PDF, 525.23 KB) August 2017
- Notices Content Templates (PDF, 593.08 KB) August 2017
- Eligibility Notice Requirements and Model Notice Overview (PDF, 4.84 MB) June 2017
- Model Notices (PDF, 571.19 KB) June 2017
2016 Model Notices
- Model Eligibility Results Pages (PDF, 801.89 KB) October 2016
- Model Eligibility Results Page Scenarios (PDF, 842.63 KB) October 2016
- FFM Transfer Message LC Presentation (PDF, 2.18 MB) October 2016
- FFM Transfer Message FAQs (PDF, 688.29 KB) October 2016
- Model Eligibility Results Page LC Presentation (PDF, 6.8 MB) August 2016
2013 Model Notices
The 2013 Model Notices Toolkit remains available for reference, however states should leverage the requirements review and notice language from the 2017 refresh (see links above), which were updated to reflect 2016 final regulations on notices and additional operational experience.
- State toolkit guide (PDF, 6.39 MB) August 2013
- Tool 1 – Statutory and regulatory review August 2013
- Tool 2 – Key messages menu set August 2013
- Tool 3 – Notices content template August 2013
- Tool 4 – Model notices August 2013
Eligibility & Verification
Information and tools to assist states in implementing relevant eligibility and verification requirements.
Alternative Benefit Plan
- Alternative Benefit Plan (PDF, 1.11 MB) October 2013
Former Foster Care Youth
- Ensuring Continuity of Coverage for Former Foster Care Youth (PDF, 1.5 MB) September 2019
- Ensuring Access to Medicaid Coverage for Former Foster Care Youth (PDF, 1.06 MB) June 2017
Information and tools to assist states in implementing strategies that implement Medicaid enrollment and care coordination strategies for eligible justice-involved populations.
- Medicaid and Justice-Involved Populations: Strategies to Increase Coverage and Care Coordination (PDF, 856.28 KB) August 2017
- Medicaid Eligibility and Enrollment for Justice-Involved Populations (PDF, 4.9 MB) February 2015
Real Time Eligibility
- Achieving real time eligibility determinations (PDF, 4 MB) June 2015
- Integrating Non-MAGI Eligibility and Enrollment (PDF, 1.71 MB) August 2017
- Streamlined eligibility and enrollment for non-MAGI populations (PDF, 9.71 MB) June 2015
Guidance for Medicaid and CHIP Eligibility Workers
- Affordable Care Act overview: a primer (PDF, 12.52 MB) November 2013
- Household composition and income eligibility detailed rules (ZIP, 20.39 MB) November 2013
- MAGI 2.0: Building MAGI Knowledge
- Verification & Reasonable Compatibility (PDF, 1.06 MB) October 2012
- Federal requirements and state flexibilities for verifying eligibility criteria May 2012
Hospital Presumptive Eligibility
Information and tools 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 (PDF, 5.34 MB) February 2014
- Model application form (PDF, 133.01 KB) February 2014
- Federal single streamlined application with required items marked for presumptive eligibility (PDF, 346.79 KB) February 2014
- Model memorandum of understanding (PDF, 223.32 KB) February 2014
- Resources for implementing the HPE Program (PDF, 55.8 KB) December 2013
- Frequently asked questions (PDF, 151.09 KB) January 2014
- Training template for qualified hospitals (PDF, 188.63 KB) December 2013
- Form templates for hospitals (PDF, 40.76 KB) December 2013
- Implementation of the Affordable Care Act’s Hospital Presumptive Eligibility option: considerations for states November 2013
Medicaid & CHIP MAGI Application Processing
- Ensuring Timely and Accurate Eligibility Determinations (PDF, 1.16 MB) July 2019
Medicaid & CHIP Renewals & 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.
- Revised Model Renewal Form (PDF, 686.34 KB) September 2015
- Updates to the draft model renewal form (PDF, 7.19 MB) September 2015
- Medicaid/CHIP renewals: state practices, lessons learned, and opportunities (PDF, 4.36 MB) August 2015
- Streamlining Medicaid and CHIP renewals (PDF, 4.36 MB) July 2014
- Coverage transitions in 1115 demonstration states (PDF, 2.27 MB) July 2013
- Example Medicaid renewal form (PDF, 235.38 KB) July 2013
- Model renewal form and considerations in 2013-2014 (PDF, 7.71 MB) 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 individuals to be determined eligible for Medicaid, CHIP, and Advanced Premium Tax Credits (APTC)/Cost Sharing Reductions (CSR).
- Telephonic Applications (PDF, 1013.8 KB) August 2013
- Integrated human services application analysis (PDF, 2.17 MB) June 2013
- High-level summary chart (PDF, 82.78 KB) June 2013
- Cross-walk of model application (PDF, 302.52 KB) June 2013
Additional resources developed through this Collaborative are available to state officials through the CMS zONE State HSI Community.