Regulatory Advisory

HHS Issues Final Medicaid Eligibility Rule

The U.S. Department of Health and Human Services (HHS) released a final rule last week covering Medicaid expansion in 2014 for individuals ages 19 to 64 with incomes of less than 133 percent of the federal poverty level. The final rule also clarifies the Children’s Health Insurance Program (CHIP) and Medicare dual eligibles. The rule states that from 2014 to 2016, the federal government will fund 100 percent of newly eligible individuals, and reduce the match to 90 percent by 2020 where it will permanently remain.

For CHIP and Medicare applications and renewals, a single “Modified Adjusted Gross Income” standard will be used to determine eligibility documented in a timely manner. The rule also provides states with flexibility as they work to implement a seamless enrollment system across exchanges, Medicaid and CHIP in order to provide a “no wrong door” policy for individuals residing in the state. The final rule is attached. Contact: Anne McLeod, (916)552-7536,; Alyssa Keefe, (202) 488-4688,