CHA News Article

Report Outlines Findings from 50-State Survey of Medicaid and CHIP Policies

The Kaiser Family Foundation has released its 14th annual 50-state survey of Medicaid and Children’s Health Insurance Program (CHIP) eligibility, enrollment, renewal and cost-sharing policies based on a survey of state program officials. It provides a snapshot of policies in place as of January 2016 and identifies changes in state policies that occurred between January 2015 and 2016. These changes provide insight into how state policies are evolving from the new baseline that was established at the end of 2014, after the first full year of ACA implementation.

The findings illustrate that the program continues to be a central source of coverage for low-income children and pregnant women nationwide and show the growth in Medicaid’s role for low-income adults through the ACA Medicaid expansion. The findings also show that, during 2015, states continued to implement the major technological upgrades and streamlined enrollment and renewal processes triggered by the ACA.

These changes are helping to connect eligible individuals to Medicaid coverage more quickly and easily, keep eligible people enrolled, and are contributing to increased administrative efficiencies. However, implementation varies across states and, as the report reveals, lingering challenges remain. State-specific information is available in Tables 1 to 21 at the end of the report.

Key report findings include:

  • Medicaid and CHIP remained the central sources of coverage for low-income children and pregnant women nationwide during 2015. As of January 2016, 48 states cover children with incomes at or above 200 percent of the federal poverty level (FPL), with 19 states extending eligibility to at least 300 percent of the FPL, while 33 states cover pregnant women with incomes at or above 200 percent of the FPL. Eligibility levels for children and pregnant women remained stable during 2015. This stability, in part, reflects the ACA’s maintenance of effort provisions, which prevent states from making any reductions in children’s eligibility through 2019.
  • Medicaid’s role for low-income adults continued to grow through the ACA Medicaid expansion. As of January 2016, 31 states have expanded Medicaid eligibility to parents and other non-disabled adults with incomes up to at least 138 percent of the FPL. This count reflects the adoption of the Medicaid expansion in three states — Alaska, Indiana and Montana — during 2015. However, in the 20 states that have not expanded, median eligibility levels are 42 percent of the FPL for parents and 0 percent of the FPL for other adults, leaving many poor adults in a coverage gap since they earn too much to qualify for Medicaid but not enough for tax credit subsidies to purchase marketplace coverage, which begin at 100 percent of the FPL.
  • As of January 2016, individuals can apply for Medicaid online or by phone in nearly all states as envisioned by the ACA (see Figure 2 in the report). All states except Tennessee have an online Medicaid application available either through the state Medicaid agency or an integrated portal that provides access to Medicaid and the state-based marketplace.
  • As of January 2016, 37 states report they can make real-time Medicaid eligibility determinations (defined as less than 24 hours) for children, pregnant women and nondisabled adults. Among the 27 states that report these groups’ share of applications that receive a real-time determination, 11 indicated that more than 50 percent of applications receive a determination in real time.
  • Coordination between state Medicaid agencies and the marketplaces improved during 2015, but challenges remain. Among the 17 states operating a state-based marketplace, 13 have a single integrated system that makes eligibility determinations for both Medicaid and marketplace coverage, eliminating the need for account transfers between programs. However, the 38 states that rely on the federally facilitated marketplace, Healthcare.gov, for marketplace eligibility and enrollment must electronically transfer accounts between Medicaid and the federally facilitated marketplace to provide access to all insurance affordability programs.
  • As implementation continues, a number of states eliminated delays in processing renewals and put streamlined renewal procedures in place as established by the ACA. When the ACA was first implemented, there was significant focus on implementing streamlined enrollment processes and establishing coordination between Medicaid and the new marketplaces. As a result, most states delayed implementing new renewal procedures, and 36 states took up a temporary option to postpone renewals for existing Medicaid or CHIP enrollees during 2014. In 2015, most states caught up on renewals and many made gains in implementing streamlined renewal procedures.

The full report is available on the Kaiser Family Foundation website.

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