Expanding Coverage Under Medicaid and CHIP

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, 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.

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

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.

Eligibility & Verification

Information and tools to assist states in implementing relevant eligibility and verification requirements.

Former Foster Care Youth

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.

Real Time Eligibility

Non-MAGI Populations

Guidance for Medicaid and CHIP Eligibility Workers

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.

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.

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).

Additional resources developed through this Collaborative are available to state officials through the CMS zONE State HSI Community.