Nearly all states are taking steps to develop faster, streamlined Medicaid enrollment systems, even if they choose to opt out of Medicaid expansion, according to a report from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.
As of Jan. 1, 2013, 47 states had applied for or received increased federal funds to make major upgrades to Medicaid enrollment systems, and 42 states had already begun their system development work. Federal regulations require all Medicaid programs to have Web-based, paperless, real-time enrollment processes that will rely on electronic data and minimize administrative burdens on individuals and eligibility workers.
Key survey findings include the following:
- The majority of states are using Web-based tools and electronic data to improve individuals’ access to coverage and administrative burdens.
These include online applications for Medicaid or CHIP, the ability to renew online, and an electronic data verification hub.
- Parents and other adults continue to face significant gaps in Medicaid coverage. In 2012, eligibility levels for children and pregnant women remained stable and strong; as of Jan. 1. 2013, the median eligibility level is 235 percent of the federal poverty level for children, or $44,861 for a family of three, and 185 percent of the poverty for pregnant women, or $35,316 for a family of three. Adult eligibility remains lower than that for children, and three states (HI, IL, and MN) scaled back coverage for adults during 2012. Only nine states provide full Medicaid coverage to other adults without dependent children. The ACA Medicaid expansion to 138 percent of the federal poverty level ($26,344 for a family of three) would significantly increase eligibility for parents in many states, with even larger potential gains for other adults. If a state does not expand Medicaid, poor adults who are uninsured will not gain access to a new affordable overage option and likely remain uninsured.
- During 2012, a majority of states did not impose additional cost-sharing requirements on families even though they continued to experience budget constraints. States generally cannot increase premiums under current federal requirements to maintain eligibility and enrollment policies until 2014. As such, premium changes were minimal. However, states are not restricted from increasing co-payments within federal program limits, and nine made such increases in 2012.
Source: Kaiser Family Foundation, January 23, 2013
Medicaid Compliance Strategies for Hospitals and Other Providers: How to Prepare for Federal Health Reform Mandates and State Initiatives is filled with articles that will help Medicaid providers understand what to expect when state or federal auditors come calling, and show how certain facilities handled major cases and settlements.