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 August 13, 2018
- Disaster Preparedness Toolkit for State Medicaid and CHIP Agencies June 2022
- Inventory of Medicaid and Chip Flexibilities and Authorities in the Event of a Disaster June 2022
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 July 2015
- Medicaid premium assistance for employer-sponsored insurance January 2015
- Cost sharing and premium rules for Medicaid November 2014
- Medicaid QHP Premium Assistance September 2014
- Children's QHP Premium Assistance 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 August 2017
- Notices Content Templates August 2017
- Eligibility Notice Requirements and Model Notice Overview June 2017
- Model Notices June 2017
2016 Model Notices
- Model Eligibility Results Pages October 2016
- Model Eligibility Results Page Scenarios October 2016
- FFM Transfer Message LC Presentation October 2016
- FFM Transfer Message FAQs October 2016
- Model Eligibility Results Page LC Presentation 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 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.
Improving Maternal Health and Extending Postpartum Coverage in Medicaid and the Children’s Health Insurance Program (CHIP)
Alternative Benefit Plan
- Alternative Benefit Plan October 2013
Former Foster Care Youth
- Ensuring Continuity of Coverage for Former Foster Care Youth September 2019
- Ensuring Access to Medicaid Coverage for Former Foster Care Youth June 2017
Guidance for Medicaid and CHIP Eligibility Workers
- Affordable Care Act overview: a primer November 2013
- Household composition and income eligibility detailed rules December 2020
- MAGI 2.0: Building MAGI Knowledge
- Part 1: Household Composition July 2016
- Part 2: Income Counting December 2020
- Verification & Reasonable Compatibility 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 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 states November 2013
Justice-Involved Populations
Information and tools to assist states in implementing strategies that implement Medicaid enrollment and care coordination strategies for eligible justice-involved populations.
- Transcript - Operational Planning for a Section 1115 Reentry Demonstration September 2023
- Operational Planning for a Section 1115 Reentry Demonstration September 2023
- Medicaid and Justice-Involved Populations: Strategies to Increase Coverage and Care Coordination August 2017
- Medicaid Eligibility and Enrollment for Justice-Involved Populations February 2015
Medicaid & CHIP MAGI Application Processing
Non-MAGI Populations
Program Integrity
- Risk Assessment Template July 2021
- Risk Assessment Template July 2021
- Risk Assessment Tool Webinar July 2021
- A recording of the webinar is available through the Regional Information Sharing System at riss.net. State Medicaid employees can request access by emailing the MII Resource mailbox at MIIResource@cms.hhs.gov.
- Program Integrity Strategies for Medicaid and CHIP Eligibility August 2020
Real Time Eligibility
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.
- Supporting Seamless Coverage Transitions for Children Moving Between Medicaid and CHIP in Separate CHIP States December 2022
- Connecting Kids to Coverage: State Outreach, Enrollment and Retention Strategies issue brief
- Ensuring Continuity of Coverage and Preventing Inappropriate Terminations – Part 2 August 2021
- Ensuring Continuity of Coverage and Preventing Inappropriate Terminations – Part 1 July 2021
- Medicaid and CHIP Renewals and Redeterminations January 2021
- Revised Model Renewal Form September 2015
- Updates to the draft model renewal form September 2015
- Medicaid/CHIP renewals: state practices, lessons learned, and opportunities August 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 individuals to be determined eligible for Medicaid, CHIP, and Advanced Premium Tax Credits (APTC)/Cost Sharing Reductions (CSR).
- Single Streamlined Application Guidance September 2021
- Telephonic Applications August 2013
- 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 CMS zONE State HSI Community.